[Neurovascular compression syndrome of the upper thoracic outlet]

Neurovascular compression syndrome of the upper thoracic outlet is a collective term encompassing various entities: cervical ribs, structural variations of the first rib, costoclavicular syndrome, fibromuscular anomalies of anterior and middle scalene muscles, pectoralis minor syndrome and various pathologies of subclavian vessels. Their combination is based on the common substrate subject to compression (neurovascular bundle passing through narrow cervicoaxillary canal).

To analyze research of etiology, pathogenesis and treatment of neurovascular compression syndrome of the upper thoracic outlet.

Cervical ribs were described by Galen. However, these ribs have been associated with symptoms of neurovascular compression only in the 18th century. In 1903, F. Bramwell identified the second possible cause of neurovascular compression (structural variations of the first rib). In 1912, T.W. Todd described narrowing of costoclavicular space. In 1920, A.A. Law described fibromuscular bands in costoclavicular space. In 1929, H.C. Naffziger and W.I. Grant pointed out the role of hypertrophy or spasm of anterior scalene muscle. In 1945, I.S. Wright described pectoralis minor muscle syndrome («hyperabduction»). The main treatment was scalenotomy. Less common option was rib or clavicle resection. Modern methods of pathogenetic treatment and less traumatic surgical approaches began to be developed only in the late 20th - early 21st centuries. All above-described entities were considered separately. The common term «thoracic outlet syndrome» does not accurately reflect the mechanism and structures subject to compression.

It seems appropriate to group all forms of thoracic outlet pathology causing neurovascular compression into a single unit (neurovascular compression syndrome of the upper thoracic outlet).