A Brief History of the Thoracic Outlet Compression Syndromes
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 clinica
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A Brief History of the Thoracic Outlet Compression Syndromes Herbert I. Machleder
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.
Prologue
H.I. Machleder, MD Department of Surgery, University of California, Los Angeles (UCLA), 10833 LeConte Blvd, Los Angeles, CA 90095-6904, USA e-mail: [email protected]
It was sometime in winter of 1994 when a newspaper reporter came upon a tattered, homeless, and destitute man living in a crude cardboard shelter under a Houston bridge. How could this be; JR Richard once one of the highest paid and most talented “All-Star” pitchers of the Houston
K.A. Illig et al. (eds.), Thoracic Outlet Syndrome, DOI 10.1007/978-1-4471-4366-6_1, © Springer-Verlag London 2013
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Astros? A giant of a man both in size (6¢8 ) and accomplishment, brought low by an odd, poorly understood disorder [1]. It remained for another iconic figure to decipher the diagnosis, the Neurologist William Fields; referred to by his contemporaries as a physician who was a “Giant” in the field of Neurology (whose members are not noted for hyperbole), and whose contributions were “monumental” [2]. After examining Richard, and studying his case, Fields wrote, in his definitive style, “All shoulder girdle compression syndromes have one common feature, namely; compression of the brachial plexus, the subclavian artery, and subclavian vein, usually between the first rib and the clavicle. With elevation of the upper limb, there is a scissorlike approximation of the clavicle superiorly and the first rib inferiorly. Grouping the various conditions under the single heading of thoracic ou
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