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 - 2024/10/13 UR - accesssurgery.mhmedical.com/content.aspx?aid=1105846596 ER -