Thoracic outlet syndrome experience in a metropolitan hospital

This clinical review emphasizes the need for cooperative management of the syndrome by the diverse and various treating disciplines. Trauma is now recognized as a much more frequent cause for persistence of the syndrome than had been previously appreciated. Reoperation in failed cases that were persistently nonresponsive to all other therapy usually shows a clear basis for symptoms such as adherence of vessels to first rib, marked local scarring and/or vascular stenosis, as well as nerve trunk adhesions. Nonoperative care is still the first choice for primary treatment. Any of the surgical disciplines can and should care for such patients so long as the surgeon is capable of performing any and all surgical procedures needed.