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Historical perspectives and anatomic considerations. Thoracic outlet syndrome
1University of Colorado Health Sciences Center, Denver, USA.
Seminars in Thoracic and Cardiovascular Surgery
|April 1, 1996
Summary
This historical review traces the evolution of understanding thoracic outlet syndrome (TOS), from early observations to modern diagnostic and surgical techniques. It highlights the role of anatomical abnormalities in causing neurovascular compression in the thoracic outlet.
Area of Science:
- Medical History
- Anatomy
- Vascular Surgery
- Neurology
Background:
- The understanding of thoracic outlet syndrome (TOS) has evolved over centuries, with initial mentions of cervical ribs dating back to Galen.
- Early 20th-century clinical studies and surgical interventions, such as first rib resection and scalenotomy, marked significant progress in managing TOS.
Observation:
- The term "thoracic outlet syndrome" was established in 1956 to define neurovascular compression at the base of the neck.
- Diagnostic advancements include arteriography, venography (1960s), and neuroelectric studies (1968), though the latter offer limited diagnostic value for neurogenic TOS.
- Recent histochemical studies reveal cellular changes in scalene muscles associated with trauma-induced TOS.
Findings:
- Thoracic outlet syndrome stems from congenital or developmental anatomical abnormalities causing compression and irritation of nerves and vessels.
- Surgical approaches like posterior periscapular and transaxillary techniques, popularized in the 1960s, are key to treating TOS.
Implications:
- Detailed understanding of these anomalies is crucial for accurate diagnosis and effective surgical treatment of patients with TOS.
- Continued research into the cellular mechanisms and anatomical variations will further refine TOS management strategies.