A brief history of the thoracic outlet compression syndromes

Abstract

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.