A Brief History of the Thoracic Outlet Compression Syndromes



The History of the Thoracic Outlet Compression Syndromes has evolved over the past 150 years, from the first well documented case in 1861, to series of patients now treated in modern prospective randomized trials. This evolution has been driven by clinical and basic research contributions from major University Medical Centers and Clinics around the globe.

The three major manifestations; Arterial, Venous, and Neurogenic were drawn together in a dramatic, tragic, and eventually transcendent series of events, summarized in a single clinical case, by the great American Neurologist William S. Fields in 1986.

The complex developmental anatomy, of this key evolutionary departure of Primates from the rest of the Mammals, remained the conundrum that shrouded the thoracic outlet from clarity. The contributions of; Embryologists, Anatomists, Neurophysiologists and Neuropathologists, coupled with astute observations of generations of Clinicians, now clearly define this unique anatomic site, and its hazards.

In reviewing this historical sequence the reader encounters a fascinating account, of a disorder that affects a diverse population including; Musicians, Athletes, Industrial Workers, as well as those who toil at Data Entry. The history also well illustrates the twists and turns of scientific discovery and clinical application, that have always encumbered our efforts to study, understand, and effectively alleviate a disorder, that can range from a curious annoyance to major disability.


Carpal Tunnel Syndrome Brachial Plexus Thoracic Outlet Syndrome Scalene Muscle Anterior Scalene Muscle 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Keith Knomes. “Resurrection: The J.R. Richard Story.” IMDB 2005, Director; Greg Carter. Production; Bellinger-BotheaX filmsGoogle Scholar
  2. 2.
    Van Horn G, Grotta JC, William S, Fields MD. Texas medical center pioneer. Ann Neurol. 2004;56(2):314.CrossRefGoogle Scholar
  3. 3.
    Fields WS, et al. Thoracic outlet syndrome: review and reference to stroke in a major league pitcher. AJR Am J Roentgenol. 1986;7:73–8.Google Scholar
  4. 4.
    Machleder HI. Thoracic outlet syndromes: new concepts from a century of discovery. Cardiovasc Surg. 1994;2(2):137–45. LCCN-Sn93002438 ISSN 0967–2109.PubMedGoogle Scholar
  5. 5.
    Coote H. Exostosis of the left transverse process of the seventh cervical vertebrae, surrounded by blood vessels and nerves, successful removal. Lancet. 1861;i:350–1.Google Scholar
  6. 6.
    Todd TW. The descent of the shoulder after birth. Its significance in the production of pressure symptoms on the lowest brachial trunk. Anat Anz. 1912;41:385–95.Google Scholar
  7. 7.
    Stopford JSB, Telford ED. Compression of the lower trunk of the brachial plexus by a first dorsal rib. Br J Surg. 1919;7:168–77.CrossRefGoogle Scholar
  8. 8.
    Adson AW, Coffey JR. Cervical rib, a method of anterior approach for relief of symptoms by division of the scalenus anticus. Ann Surg. 1927;85:839–53.PubMedGoogle Scholar
  9. 9.
    Naffziger HC, Grant WT. Neuritis of the brachial plexus, mechanical in origin: the scalenus syndrome. Surg Gynecol Obstet. 1938;67:722–30.Google Scholar
  10. 10.
    Ochsner A, Gage M, DeBakey M. Scalenus anticus (Naffziger syndrome). Am J Surg. 1935;28:669–95.CrossRefGoogle Scholar
  11. 11.
    Milliez PY Contribution A L’Etude De L’Ontogenese Des Muscles Scalenes (Reconstruction D’Un Embryon De 2.5 cm) June 28, 1991 Universite Paris 1 Pantheon-Sorbonne Musee De L’Homme, Museum D’Histoire NaturelleGoogle Scholar
  12. 12.
    Lang J. Tropographische Anatomie de Plexus brachialis und Thoracic Outlet Syndrom. Berlin: Walter de Gruyter; 1985.CrossRefGoogle Scholar
  13. 13.
    Machleder HI, Moll F, Verity MA. The anterior scalene muscle in thoracic outlet compression syndrome. Histochemical and morphometric studies. Arch Surg. 1986;121:1141–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Pascarelli EF, Hsu YP. Understanding work-related upper extremity disorders. J Occup Rehabil. 2001;11(1):1–21.PubMedCrossRefGoogle Scholar
  15. 15.
    Jordon SE, et al. Diagnosis of thoracic outlet syndrome using electrophysiologically guided anterior scalene blocks. Ann Vasc Surg. 1998;12:260–4.CrossRefGoogle Scholar
  16. 16.
    Jordon SE, et al. Selective botulinum chemodenervation of the scalene muscles for treatment of neurogenic thoracic outlet syndrome. Ann Vasc Surg. 2000;14:365–9.CrossRefGoogle Scholar
  17. 17.
    Clagett OT. Research and prosearch. J Thorac Cardiovasc Surg. 1962;44:153–66.PubMedGoogle Scholar
  18. 18.
    Roos DB. Transaxillary approach for first rib resection to relieve thoracic outlet syndrome. Ann Surg. 1966;163:354–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Roos DB. Experience with first rib resection for thoracic outlet syndrome. Ann Surg. 1971;173:429–33.PubMedCrossRefGoogle Scholar
  20. 20.
    Dale WA. Thoracic outlet compression syndrome: Critique in 1982. Arch Surg. 1982;117:1437–45.PubMedCrossRefGoogle Scholar
  21. 21.
    Roos DB. Congenital anomalies associated with thoracic outlet syndrome. Am J Surg. 1976;132:771–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Makhoul RG, et al. Developmental anomalies at the thoracic outlet: an analysis of 200 consecutive cases. J Vasc Surg. 1992;16:534–45.PubMedCrossRefGoogle Scholar
  23. 23.
    Machleder HI. Transaxillary operative management of thoracic outlet syndrome. Current therapy in vascular surgery. 2nd ed. Philadelphia: B.C. Decker; 1991. ISBN 1-55664-262-8.Google Scholar
  24. 24.
    Eaton LM. Neurological causes of pain in the upper extremities; with particular reference to syndromes of protruded intervertebral disk in the cervical region and mechanical compression of the brachial plexus. Surg Clin North Am. 1946;4(6):810–32.Google Scholar
  25. 25.
    Cormier JM, et al. Arterial complications of the thoracic outlet syndrome: fifty-five operative cases. J Vasc Surg. 1989;9:778–87.PubMedGoogle Scholar
  26. 26.
    Durham JR, Yao JST, Pierce WH, et al. Arterial injuries in the thoracic outlet syndrome. J Vasc Surg. 1995;21:57–70.PubMedCrossRefGoogle Scholar
  27. 27.
    Gelabert HA, et al. Diagnosis and management of arterial compression at the thoracic outlet. Ann Vasc Surg. 1997;11:359–66.PubMedCrossRefGoogle Scholar
  28. 28.
    Adams JT, DeWeese JA. “Effort” thrombosis of the axillary and subclavian veins. J Trauma. 1971;11:923–30.PubMedCrossRefGoogle Scholar
  29. 29.
    Adams JT, DeWeese JA, Mahoney EB, Rob CG. Intermittent subclavian vein obstruction without thrombosis. Surgery. 1968;68:147–65.Google Scholar
  30. 30.
    Zimmerman R, Morl H, et al. Urokinase therapy of subclavian-axillary vein thrombosis. Klin Wochenschr. 1981;59:851–6.CrossRefGoogle Scholar
  31. 31.
    Taylor LM, Mcallister WR, et al. Thrombolytic therapy followed by first rib resection for spontaneous (“effort”) subclavian vein thrombosis. Am J Surg. 1985;149:644–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Perler BA, Mitchel SE. Percutaneous transluminal angioplasty and transaxillary first rib resection: a multidisciplinary approach to the thoracic outlet compression syndrome. Am Surg. 1986;52:485–97.PubMedGoogle Scholar
  33. 33.
    Kunkel JM. Treatment of Paget-Schroetter syndrome. A staged, multidisciplinary approach. Arch Surg. 1989;124:1153–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Machleder HI. Evaluation of a new treatment strategy for Paget-Schroetter syndrome: spontaneous thrombosis of the axillary-subclavian vein. J Vasc Surg. 1993;17:305–17.PubMedCrossRefGoogle Scholar
  35. 35.
    Daube JR. Nerve conduction studies in the thoracic outlet syndrome. Neurology. 1975;25:347–52.Google Scholar
  36. 36.
    Eisen A, et al. Application of F wave measurements in the differentiation of proximal and distal upper limb entrapments. Neurology. 1977;27:662–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Yiannikas C, Walsh JC. Somatosensory evoked responses in the diagnosis of thoracic outlet syndrome. J Neurol Neurosurg Psychiatry. 1983;46:234–40.PubMedCrossRefGoogle Scholar
  38. 38.
    Machleder HI, Moll F, Nuwer M, Jordan S. Somatosensory evoked potentials in the assessment of thoracic outlet compression syndrome. J Vasc Surg. 1987;6:177–84.PubMedCrossRefGoogle Scholar
  39. 39.
    Haghighi SS, et al. Sensory and motor evoked potential findings in patient with thoracic outlet syndrome. Electromyogr Clin Neurophysiol. 2005;45(3):149–54.PubMedGoogle Scholar
  40. 40.
    Relman AS. Editorial: responsibilities of authorship: where does the buck stop? N Engl J Med. 1984;310:1048–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Hughes ESR. Venous obstruction in the upper extremity (Paget-Schroetter’s syndrome). Int Abstr Surg. 1949;88:89–127.Google Scholar
  42. 42.
    Machleder HI. Vascular disorders of the upper extremity. 3rd ed. Armonk: Wiley-Blackwell; 1999. ISBN 978-0-87993-409-5.Google Scholar
  43. 43.
    Gilliat RW, et al. Wasting of the hand associated with a cervical rib or band. J Neurol Neurosurg Psychiatry. 1970;33:615–24.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of California, Los Angeles (UCLA)Los AngelesUSA

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