TY  - CHAP
M1  - Book, Section
TI  - Thoracic Outlet Syndromes
A1  - Urschel, Harold C.
A1  - Mark, Pool J.
A1  - Patel, Amit N.
A2  - Sugarbaker, David J.
A2  - Bueno, Raphael
A2  - Colson, Yolonda L.
A2  - Jaklitsch, Michael T.
A2  - Krasna, Mark J.
A2  - Mentzer, Steven J.
A2  - Williams, Marcia
A2  - Adams, Ann
PY  - 2015
T2  - Adult Chest Surgery, 2e
AB  - Thoracic  outlet  syndrome  (TOS)  is  a  condition  that  arises  from  the  compression  of  one  or  more  of  the  neurovascular  structures  that  traverse  the  superior  aperture  of  the  chest.  The  name  was  previously  designated  according  to  the  etiology  of  the  compression,  that  is,  scalenus  anticus,  costoclavicular,  hyperabduction,  cervical  rib,  or  first  rib  syndrome.  Most  compressive  factors  operate  against  the  first  rib  and  produce  a  variety  of  symptoms,  depending  on  which  neurovascular  structures  are  compressed.  These  factors,  along  with  common  etiologies  and  symptoms,  are  illustrated  in  Figure  143-1.  My  introduction  (H.U.)  to  TOS  came  in  1947  at  Princeton  University,  where,  as  a  member  of  the  undefeated  freshman  football  team,  my  neck  was  knocked  severely  to  the  right,  paralyzing  my  arm  for  several  days.  After  the  season,  I  was  sent  by  train  to  Johns  Hopkins  Hospital  to  be  evaluated  by  Dr.  George  Bennett,  the  eminent  orthopedic  surgeon  who  had  recently  operated  on  Joe  DiMaggio's  knee.  He  made  the  diagnosis  of  a  cervical  rib  syndrome  on  the  right  and  offered  me  an  operation  or  a  brace.  Recognizing  early  that  surgery  was  for  others,  I  tried  the  brace.  A  piece  of  stainless  steel  covered  only  with  leather  was  fashioned  on  my  shoulder  pad.  It  extended  up  past  my  right  ear  to  prevent  my  neck  from  being  driven  to  the  right.  I  used  this  for  the  next  year.  However,  in  those  days,  no  one  wore  a  facemask,  and  I  was  often  chagrined  to  find  a  piece  of  nose  or  face  or  teeth  on  the  ground  after  a  substantial  block  from  the  single-wing  formation.  For  this  reason,  the  NCAA  ultimately  outlawed  the  brace.  Subsequently,  the  foam  rubber  “doughnut”  was  developed  to  prevent  the  neck  from  being  forced  to  extremes  in  any  direction.  It  is  commonly  used  today.  Conservative  treatment,  then  as  now,  is  usually  effective.  With  no  surgery,  I  contributed  significantly  to  our  undefeated  team,  which  produced  “Coach  of  the  Year”  Charles  W.  Caldwell,  Jr.,  and  the  last  Heisman  Trophy  winner  in  the  Ivy  League,  Richard  W.  Kazmaier,  Jr.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accesssurgery.mhmedical.com/content.aspx?aid=1105846596
ER  -