During the past 5 decades, the recognition and management of
thoracic outlet syndrome (TOS) have evolved. This article elucidates these changes and improvements in the diagnosis and management of TOS at Baylor University Medical Center. The most remarkable change over the past 50 years is the use of nerve conduction velocity to diagnose and monitor patients with nerve compression. Recognition that procedures such as
breast implantation and
median sternotomy may produce TOS has been revealing. Prompt thrombolysis followed by surgical venous
decompression for
Paget-Schroetter syndrome has markedly improved results compared with the conservative anticoagulation approach; thrombolysis and prompt first rib resection is the optimal treatment for most patients with
Paget-Schroetter syndrome. Complete first rib extirpation at the initial procedure markedly reduces the incidence of recurrent
neurologic symptoms or the need for a second procedure.
Chest pain or pseudoangina can be caused by TOS. Dorsal
sympathectomy is helpful for patients with sympathetic maintained
pain syndrome or
causalgia and patients with recurrent TOS symptoms who need a second procedure.