ABSTRACT

The large number of names given to compression syndromes of the brachial plexus and the subclavian vessels during the last century bears testimony to the difficulty in teaching this condition, with its difficult diagnostic reputation and even more controversial treatment. Narakas (1991) has described more than 18 different types of compression syndromes arising between the cervical spine and the lateral border of the pectoralis major. From our point of view, these can, without oversimplifying, be named under the general term (in French) syndrome de la traversée cervico-thoracobrachiale (STCTBX A review of the last 250 references in the literature which deal with STCTB in general, and which in the English literature come under the term ‘thoracic outlet syndrome’ (TOS), reveals a wide variation in the aetiological, diagnostic and therapeutic approach. This condition is managed by vascular-trained surgeons, as well as upper limb surgeons trained in brachial plexus and peripheral nerve surgery. Each speciality tends to prefer its own pathological description, on one hand stressing the importance of vascular syndromes, on the other stressing the frequency of neurological syndromes and combined neurovascular syndromes. To simplify the approach of these two specialties, the treatment options can be described in the following way.