Many physicians are only briefly exposed to the concepts of thoracic outlet syndrome during medical school, or during their residency.  Due to this brief exposure and to the complexity of thoracic outlet syndrome, many physicians recall the controversy more than they recall specific information about thoracic outlet syndrome.  Fortunately, there is a very large body of medical literature that clarifies and confirms the existence, diagnosis, and treatment of thoracic outlet syndrome.

Thoracic outlet syndrome was first recognized more than 180 years ago.  The history of thoracic outlet syndrome includes some of the most renowned names in medical history:

1. Sir James Paget is widely recognized as one of the founders of modern pathology, and was one of the most famous surgeons in London in the late 1800s.  Sir Paget first described thrombosis of the subclavian-axillary vein occurring in the thoracic outlet in 1875.
2. Dr. William Halsted was one of the pioneers of modern surgical technique in the United States, using aseptic technique and novel wound closure techniques to advance the safety and efficacy of surgery. He performed the first emergency blood transfusion, the first radical mastectomy, the first nerve block, the first inguinal hernia repair, and invented the surgical glove. Dr. Halsted was named the first surgeon-in-chief of the Johns Hopkins Hospital, and was the first professor of surgery at Johns Hopkins Medical School.  Dr. Halsted published a number of papers providing descriptions of subclavian artery aneurysms caused by cervical ribs in the late 1910s.
3. Dr. Alfred Washington Adson created and headed the Section of Neurological Surgery at the Mayo Clinic. He was a pioneer in American surgery, and was a founding member and president of the Society of Neurological Surgeons. Adson and Coffey first suggested the mechanism of the anterior scalene muscle causing upper extremity neurovascular compression in patients with cervical ribs in 1927.
4. Dr. Howard Christian Naffziger, who trained under eminent surgeons William Halsted and Harvey Cushing, became one of the most esteemed neurosurgeons of his time. He created the division of Neurosurgery and served as Chairman of the Department of Surgery at University of California San Francisco, was elected president of the American College of Surgeons, and was Chairman of the committee that established the American Board of Neurological Surgeons. Naffziger and Grant first introduced the concept of neurovascular compression in the thoracic outlet due to scalene muscle anomalies, without the presence of a cervical rib. They performed the first scalenotomies for relief of these symptoms in the 1930s.
5. Dr. Alton Ochsner was named Chairman of Surgery at Tulane Medical School at the young age of 31, and founded the world-famous Ochsner clinic at Charity Hospital in New Orleans, which remains one of the pre-eminent surgical teaching programs in the country. Dr. Ochsner was the first to report the link between cigarette smoking and lung cancer, and he trained some of the most prominent surgeons of the time, including Dr. Michael DeBakey. Dr. DeBakey is one of the most renowned cardiovascular surgeons in the world.  He created the concept that became the Mobile Army Surgical Hospital (M*A*S*H unit) that had stellar success during the Korean War. Dr. DeBakey was one of the first cardiothoracic surgeons to perform coronary bypass surgery, was the first man to perform carotid endarterectomy, and made numerous other contributions and innovations in cardiovascular surgery, including work on the Dacron artificial graft, the heart-lung machine, and the artificial heart. Drs. Ochsner, DeBakey, and Mims Gage at LSU published a comprehensive study of patients with symptoms of neurovascular compression in the thoracic outlet in the absence of a cervical rib in 1935, for which they coined the term, “Scalenus Anticus Syndrome”.

Our understanding of thoracic outlet syndrome has rapidly grown over the past several decades.  In the last 50 years, over 1700 peer-reviewed journal articles regarding thoracic outlet syndrome have been published, with over 450 peer-reviewed articles published in the last 10 years alone. Medical researchers have published their extensive experiences evaluating and treating large numbers of patients with thoracic outlet syndrome at prestigious institutions such as Johns Hopkins University, Harvard Medical School, Yale University, University of Pennsylvania, New York University, Northwestern University Medical School, Washington University, University of California San Francisco, University of Colorado, University of Washington, Thomas Jefferson University, The Mayo Clinic, University of Michigan, University of Texas Southwestern Medical School, Baylor University, Tulane University, Louisiana State University and University of California Los Angeles(1-45). Many major university and teaching hospitals have developed dedicated clinics for the diagnosis and treatment of thoracic outlet syndrome, including Stanford University, University of Washington, University of Tennessee, University of Illinois Medical Center, Strong Memorial Hospital, Columbia University, Washington University, Emory University, University of Alabama, Cornell University, University of Minnesota, University of Pittsburgh, University of Wisconsin, Ohio State University, University of Southern California, University of California Los Angeles, and Chicago University. TOS is also discussed on important medical websites available to the public and to medical practitioners, including WebMD/eMedicine, The National Institute of Neurological Disorders and Stroke, The National Pain Foundation, MedicineNet, MDConsult, The Spinal Injury Foundation and MedScape.