{"id":20666,"date":"2026-04-09T11:55:14","date_gmt":"2026-04-09T11:55:14","guid":{"rendered":"https:\/\/hlsllc.org\/tos\/?page_id=20666"},"modified":"2026-04-14T10:21:03","modified_gmt":"2026-04-14T10:21:03","slug":"history-of-tos","status":"publish","type":"page","link":"https:\/\/hlsllc.org\/tos\/history-of-tos\/","title":{"rendered":"History of TOS"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"20666\" class=\"elementor elementor-20666\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4b5452e e-con-full e-flex e-con e-parent\" data-id=\"4b5452e\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-496c70d elementor-widget elementor-widget-heading\" data-id=\"496c70d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">History of Thoracic Outlet Syndrome\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-76a580c e-con-full e-flex e-con e-parent\" data-id=\"76a580c\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-8d95957 e-con-full e-flex e-con e-child\" data-id=\"8d95957\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-83c774e elementor-widget elementor-widget-text-editor\" data-id=\"83c774e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<div class=\"fusion-title fusion-title-text fusion-title-size-paragraph\">\n<p class=\"fusion-title-heading title-heading-left\">Table of Contents<\/p>\n<\/div>\n\n<div class=\"awb-toc-el\">\n<div class=\"awb-toc-el__content\">\n\n<ul class=\"awb-toc-el__list\">\n\n<!-- FIRST GROUP -->\n<li><a href=\"#toc_The_Cervical_Rib_Syndrome\">The Cervical Rib Syndrome<\/a><\/li>\n\n<li>\n<a href=\"#toc_Cervical_Rib_Syndromes_without_a_Cervical_Rib\">\nCervical Rib Syndromes without a Cervical Rib\n<\/a>\n<\/li>\n\n<li>\n<a href=\"#toc_Unification_ofThoracic_Outlet_Syndromes_and_the_Modern_TOS\">\nUnification of Thoracic Outlet Syndromes and the Modern TOS Era\n<\/a>\n<\/li>\n\n<li>\n<a href=\"#toc_Future_Directions_of_TOS\">Future Directions of TOS<\/a>\n<\/li>\n\n<!-- HISTORY GROUP -->\n<li>\n\n<a href=\"#toc_History_of_the_name_Thoracic_Outlet_Syndrome\">\nHistory of the name \u2018Thoracic Outlet Syndrome\u2019\n<\/a>\n\n<ul>\n\n<li><a href=\"#toc_Cervical_rib_syndrome\">Cervical rib syndrome<\/a><\/li>\n<li><a href=\"#toc_Brachial_Compression_Neuritis\">Brachial Compression Neuritis<\/a><\/li>\n<li><a href=\"#toc_Scalenus_anticus_syndrome\">Scalenus anticus syndrome<\/a><\/li>\n<li><a href=\"#toc_Naffziger_syndrome\">Naffziger syndrome<\/a><\/li>\n<li><a href=\"#toc_Costoclavicular_syndrome\">Costoclavicular syndrome<\/a><\/li>\n<li><a href=\"#toc_Costoclavicular_compression_syndrome\">Costoclavicular compression syndrome<\/a><\/li>\n<li><a href=\"#toc_Hyperabduction_syndrome\">Hyperabduction syndrome<\/a><\/li>\n<li><a href=\"#toc_Subcoracoid_pectoralis_minor_tendon_syndrome\">Subcoracoid pectoralis minor tendon syndrome<\/a><\/li>\n<li><a href=\"#toc_Wright_syndrome\">Wright syndrome<\/a><\/li>\n<li><a href=\"#toc_Brachiocephalic_syndrome\">Brachiocephalic syndrome<\/a><\/li>\n<li><a href=\"#toc_Brachiocephalic_vascular_syndrome\">Brachiocephalic vascular syndrome<\/a><\/li>\n<li><a href=\"#toc_Nocturnal_paresthetic_brachialgia\">Nocturnal paresthetic brachialgia<\/a><\/li>\n<li><a href=\"#toc_Brachialgia_statica_paresthetica\">Brachialgia statica paresthetica<\/a><\/li>\n<li><a href=\"#toc_Effort_thrombosis_of_the_subclavian_vein\">Effort thrombosis of the subclavian vein<\/a><\/li>\n<li><a href=\"#toc_PagetSchroetter_syndrome\">Paget-Schroetter syndrome<\/a><\/li>\n<li><a href=\"#toc_Axillarysubclavian_vein_thrombosis_ASVT\">Axillary-subclavian vein thrombosis (ASVT)<\/a><\/li>\n<li><a href=\"#toc_Cervicobrachial_Syndrome\">Cervicobrachial Syndrome<\/a><\/li>\n<li><a href=\"#toc_First_thoracic_rib_syndrome\">First thoracic rib syndrome<\/a><\/li>\n<li><a href=\"#toc_Superior_outlet_syndrome\">Superior outlet syndrome<\/a><\/li>\n<li><a href=\"#toc_Fractured_claviclerib_syndrome\">Fractured clavicle-rib syndrome<\/a><\/li>\n<li><a href=\"#toc_Cervical_rib_and_band_syndrome\">Cervical rib and band syndrome<\/a><\/li>\n<li><a href=\"#toc_Thoracic_inlet_syndrome\">Thoracic inlet syndrome<\/a><\/li>\n<li><a href=\"#toc_Pectoralis_minor_syndrome\">Pectoralis minor syndrome<\/a><\/li>\n<li><a href=\"#toc_Cervicodorsal_syndrome\">Cervicodorsal syndrome<\/a><\/li>\n<li><a href=\"#toc_Cervicoaxillary_syndrome\">Cervicoaxillary syndrome<\/a><\/li>\n<li><a href=\"#toc_Thoracic_Outlet_Syndrome\">Thoracic Outlet Syndrome<\/a><\/li>\n<li><a href=\"#toc_Thoracic_Outlet_Compression_Syndrome\">Thoracic Outlet Compression Syndrome<\/a><\/li>\n\n<\/ul>\n\n<\/li>\n\n<!-- CONCLUSION -->\n<li>\n<a href=\"#toc_History_of_Thoracic_Outlet_Syndrome_Conclusion\">\nHistory of Thoracic Outlet Syndrome: Conclusion\n<\/a>\n<\/li>\n\n<li>\n<a href=\"#toc_NeoVista_MRI_for_Thoracic_Outlet_Syndrome__1\">\nNeoVista\u00ae MRI for Thoracic Outlet Syndrome\n<\/a>\n<\/li>\n\n<\/ul>\n\n<\/div>\n<\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-4300a75 e-con-full e-flex e-con e-child\" data-id=\"4300a75\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-f84984f e-con-full e-flex e-con e-parent\" data-id=\"f84984f\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-f173272 e-con-full e-flex e-con e-child\" data-id=\"f173272\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-05d2efe elementor-widget elementor-widget-heading\" data-id=\"05d2efe\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_The_Cervical_Rib_Syndrome\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">The Cervical Rib Syndrome\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b05868b elementor-widget elementor-widget-text-editor\" data-id=\"b05868b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>A cervical rib is an extra rib in the lower neck, above the normal first rib. Overall, cervical ribs are seen in about 0.5 to 1% of the human population. In detail, a cervical rib may be unilateral or bilateral, small or large, free-floating or fused to the first rib on the same side. While many physicians associate cervical ribs with\u00a0<a class=\"wpil_keyword_link\" title=\"thoracic outlet syndrome\" href=\"https:\/\/www.tosmri.com\/what-is-thoracic-outlet-syndrome\/thoracic-outlet-syndrome\/\" data-wpil-keyword-link=\"linked\" data-wpil-monitor-id=\"42\">thoracic outlet syndrome<\/a>, the presence of a cervical rib does not prove or disprove\u00a0thoracic outlet syndrome. Demonstration of cervical ribs goes back centuries, but association with\u00a0TOS was only demonstrated in the early 19th\u00a0century.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-81b6e34 elementor-widget elementor-widget-n-accordion\" data-id=\"81b6e34\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;default_state&quot;:&quot;all_collapsed&quot;,&quot;max_items_expended&quot;:&quot;one&quot;,&quot;n_accordion_animation_duration&quot;:{&quot;unit&quot;:&quot;ms&quot;,&quot;size&quot;:400,&quot;sizes&quot;:[]}}\" data-widget_type=\"nested-accordion.default\">\n\t\t\t\t\t\t\t<div class=\"e-n-accordion\" aria-label=\"Accordion. Open links with Enter or Space, close with Escape, and navigate with Arrow Keys\">\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-1360\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"1\" tabindex=\"0\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-1360\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\">  150 A.D. <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-1360\" class=\"elementor-element elementor-element-e8c1536 e-con-full e-flex e-con e-child\" data-id=\"e8c1536\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-f4e98f4 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"f4e98f4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Galen-Finding-Skeleton-Cropped-150x150-1.jpg\" class=\"attachment-full size-full wp-image-20683\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\"> Galen<\/h3><p class=\"elementor-image-box-description\">The cervical rib was first described in 150 A.D. by Galen. In general, dissection of the human body was forbidden at the time. However, Galen, the Greek anatomist and court physician to Marcus Aurelius, was allowed to do so, and published several texts on anatomy. In reality, Galen\u2019s work was based in large part on dissections of apes. For several centuries, human dissection remained forbidden, and physicians learned anatomy only through Galen\u2019s texts.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-1361\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"2\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-1361\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1500 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-1361\" class=\"elementor-element elementor-element-f290a3b e-con-full e-flex e-con e-child\" data-id=\"f290a3b\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-cc96872 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"cc96872\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Andreas_Vesalius-Pierre_Poncet-150x150-1.jpg\" class=\"attachment-full size-full wp-image-20687\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Andreas Vesalius<\/h3><p class=\"elementor-image-box-description\">Andreas Vesalius is known as the father of modern anatomy. For a century and a half, Galen\u2019s work had been accepted without question, and dissections of the human body had been essentially forbidden. Physicians learned human anatomy only by studying the texts of Galen. But Vesalius changed that.\n\nVesalius came from a family of prominent physicians, and immediately upon graduating from the University of Padua became the chair of Surgery and Anatomy. Vesalius replaced the reliance on Galen\u2019s published textbooks by instituting the rigorous and meticulous direct study of the human body through dissection of cadavers. Often, Vesalius taught his students by performing dissections personally for them. Vesalius created large volumes of accurate drawings, and eventually published an updated version of Galen\u2019s anatomic textbook, Institutiones Anatomicae.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-87475bf elementor-widget elementor-widget-text-editor\" data-id=\"87475bf\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Vesalius was criticized for this work, as Galen\u2019s work was considered definitive and final. In fact, several years later, Vesalius established that Galen\u2019s work had in fact been based on dissections of barbary apes rather than of humans. He then published a corrected version of Galen\u2019s\u00a0<i>Opera omnia<\/i>, which brought further criticism. Vesalius eventually published the seven-volume\u00a0<i>De humani corporis fabrica (On the fabric of the human body)<\/i>, now considered the foundation of modern anatomic study. Vesalius dedicated this work to Emperor Charles V, and eventually became Imperial physician of Charles\u2019 court. Nonetheless, criticism of Vesalius\u2019 work continued for many years.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-1362\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"3\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-1362\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1615 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-1362\" class=\"elementor-element elementor-element-94b0fb1 e-con-full e-flex e-con e-child\" data-id=\"94b0fb1\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-8ee2eb3 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"8ee2eb3\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Microcosmographia-Crooke-1615-150x150-1.jpg\" class=\"attachment-full size-full wp-image-20691\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Helkiah Crooke<\/h3><p class=\"elementor-image-box-description\">Crooke described cervical ribs in man.\n\nHelkiah Crooke served as Court physician to King James I of England. Crooke was also the first qualified doctor to be appointed Keeper of Royal Bethlem Hospital. This term Bedlam originated here.\n\nCrooke had studied all the anatomy texts available in his day, and combined them with his personal experience and knowledge. Crooke had treated William Jaggard, who later published William Shakespeare. In 1615, Jaggard published Crooke\u2019s 1000 page book, Mikrokosmographia: A Description of the Body of Man. Despite a significant amount of controversy, Crooke\u2019s book became extremely popular, and was reprinted multiple times.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2798706 elementor-widget elementor-widget-text-editor\" data-id=\"2798706\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Crooke described cervical ribs thusly: \u201cThey are commonly both in men and in women on each side twelve, oftener more than fewer. For Nature would rather there should be an abundance than want. And in a publick, anatomy when a male factor was cut up, Bauhine found thirteen on each side; the first on the left side was perfect, but the first on the right side was imperfect. Fallopius also twice found one too many, Columbus once eleven at Padua.\u201d<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-1363\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"4\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-1363\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1743 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-1363\" class=\"elementor-element elementor-element-fa593d3 e-con-full e-flex e-con e-child\" data-id=\"fa593d3\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-a18ffdd elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"a18ffdd\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Hunault-Francois-Joseph-Cropped-150x150-1.jpg\" class=\"attachment-full size-full wp-image-20695\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Fran\u00e7ois Joseph Hunault<\/h3><p class=\"elementor-image-box-description\">The cervical rib was again \u201crediscovered\u201d by Fran\u00e7ois Joseph Hunault in 1743. Hunault described and categorized supernumerary ribs in humans, including cervical ribs.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-1364\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"5\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-1364\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1818 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-1364\" class=\"elementor-element elementor-element-24f6854 e-con-full e-flex e-con e-child\" data-id=\"24f6854\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-27a504e elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"27a504e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Astley-Cooper-Standing-Color-1-150x150-1.jpg\" class=\"attachment-full size-full wp-image-20696\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Sir Astley Cooper<\/h3><p class=\"elementor-image-box-description\">Sir Astley Cooper was one of the leading surgeons of his day, publishing seminal work on the repair of inguinal hernias, and becoming renowned as a vascular surgeon. He was named sergeant surgeon to Kings George IV and William IV, and to Queen Victoria, and founded the famous medical school at Guy\u2019s Hospital in London\n\nEven though the cervical rib had been known for centuries, its effect on nearby structures was not documented until 1818, when Cooper described a young woman with pulselessness and gangrenous spots on her fingers, in conjunction with a palpable hard mass at the base of the neck. Cooper described, \u201cI have however seen an exostosis arise from the sixth or seventh cervical vertebra, or perhaps from both\u201d when introducing this case. Cooper attributed the patient\u2019s symptoms to \u201ca projection of the lower cervical vertebra towards the clavicle, and consequent pressure upon the subclavian artery.\u201d Whether he in fact described a cervical rib or a C7 exostosis is unclear, but is a moot point. He had certainly presented the first description of arterial TOS.\n\nThus began the era of the Cervical Rib Syndrome.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-1365\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"6\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-1365\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1831 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-1365\" class=\"elementor-element elementor-element-eca5386 e-con-full e-flex e-con e-child\" data-id=\"eca5386\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-334649f elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"334649f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Subclavian-Aneurysm-Cervical-Rib-150x150-1.jpg\" class=\"attachment-full size-full wp-image-20700\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">H. Mayo<\/h3><p class=\"elementor-image-box-description\">Mayo likely provided the first description of a subclavian artery aneurysm associated with a cervical rib.\n\nAs noted by Halsted in 1916, Mayo had described, \u201cRight subclavian artery flattened. Unusual width.\u201d Mayo\u2019s description predated several other similar descriptions, including Adams in 1836, J. Mason Warren in 1849, and W.H. Willshire in 1860, who wrote, \u201c\u2026attention was drawn to a pulsation felt in the space corresponding to the subclavian triangle, first observed about six months ago, and which proves to be, so far as can be made out by examination, a supernumerary rib arising above the first\u2026\u201d.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-1366\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"7\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-1366\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1853 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-1366\" class=\"elementor-element elementor-element-914d4a1 e-con-full e-flex e-con e-child\" data-id=\"914d4a1\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-5a76abd elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"5a76abd\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/John-Hilton-Cropped-150x150-1.jpg\" class=\"attachment-full size-full wp-image-20704\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">John Hilton<\/h3><p class=\"elementor-image-box-description\">John Hilton, a British surgeon, describes gangrene of the arm in a patient with compression of the subclavian artery caused by an exostosis of the first rib.\n\nIn 1849, Dr. Hilton became a full surgeon at Guy\u2019s Hospital in London, and Professor of Anatomy and Surgery in the Royal College of Surgeons in 1860. Dr. Hilton performed one of the first recorded surgeries for an internal hernia with bowel strangulation, and was the first to use internal sphincterotomy for the treatment of anal fissure. The \u2018White Line of Hilton\u2019 he described is still a widely-recognized anatomic landmark for colorectal surgeons.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-1367\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"8\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-1367\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1861 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-1367\" class=\"elementor-element elementor-element-6a635f8 e-con-full e-flex e-con e-child\" data-id=\"6a635f8\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-2a57a6b elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"2a57a6b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Holmes-Coote-1868-Cropped-1-150x150-1.jpg\" class=\"attachment-full size-full wp-image-20708\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Holmes Coote<\/h3><p class=\"elementor-image-box-description\">Holmes Coote performed the first TOS surgery.\n\nA 26 year-old female servant described a hard mass in her left lower neck, present since childhood. The \u201ctumor\u201d had grown recently, and she experienced paresthesias in the tips of her fingers, with loss of pulses at the wrist, wasting of muscles in the arm, and weakness leading to dropping of items.\n\nMr. Coote explored the area while the patient was \u201cfully under the influence of chloroform.\u201d He noted a bony \u2018tumor,\u2019 which he had to divide from the cervical vertebra. He also found it was attached to the first rib anteriorly. He removed as much of the \u2018tumor\u2019 as he could, and pulses returned in the left upper extremity.\n\nCoote described his trepidation at exploring this area thusly: \u201cBut the region was not a pleasant one for any proceeding demanding the use of the knife. The subclavian artery and vein were in front; the axillary plexus of nerves lay spread out above; below, the apex of the lung, covered by the pleura, rose up in dangerous proximity; on the scalenus was the phrenic nerve; while towards the mesial line were the important vessels and nerves passing to the head, together with the vertebral vessels and thoracic duct. You can understand, therefore, why I was cautious in what I did.\u201d\nThe bony tumor was referred to as \u201can exostotic growth from the transverse process of the seventh cervical vertebra,\u201d and \u201ca development of the costal element, the rib, of the seventh cervical vertebra.\u201d\n\nThus, Coote became the first person to surgically treat a TOS patient.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-1368\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"9\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-1368\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1869 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-1368\" class=\"elementor-element elementor-element-534f09b e-con-full e-flex e-con e-child\" data-id=\"534f09b\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-8b9b0f4 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"8b9b0f4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Bilateral-cervical-ribs-skeleton-specimen-circa-1905-Cropped-1-150x150-1.jpg\" class=\"attachment-full size-full wp-image-20709\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Gruber<\/h3><p class=\"elementor-image-box-description\">Gruber published a classification system for cervical ribs. His classification was based on the length of the cervical rib and its attachment to the first rib.<br>\n\nType 1: Cervical rib extends to the transverse process of C7\n\n<br>Type 2: Cervical rib extends beyond the transverse process with no connection to the first thoracic rib\n\n<br>Type 3: Cervical rib extends beyond the transverse process with partial fusion to the first rib by fibrous bands or cartilage\n\n<br>Type 4: Cervical rib is completely fused to the first rib by a bony pseudoarticulation<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-1369\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"10\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-1369\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1875 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-1369\" class=\"elementor-element elementor-element-082bfa6 e-con-full e-flex e-con e-child\" data-id=\"082bfa6\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-b362bde elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"b362bde\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Sir-James-Paget-150x150-1.jpg\" class=\"attachment-full size-full wp-image-20713\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Sir James Paget<\/h3><p class=\"elementor-image-box-description\">In London in 1875, Sir James Paget first describes venous TOS.\n\nSir Paget is widely regarded as one of the two founders of modern pathology, along with Rudolf Virchow in Germany.  He first established himself as a famous surgeon in London by mastering the major English, French, German, Dutch, and Italian medical literature of his time, and by applying a strict scientific discipline to the study of human physiology as it applied to surgery. Following this, in the field of pathology, Sir Paget\u2019s work was groundbreaking. Sir Paget established the scientifically rigorous use of the microscope in the study of human infection and tumors.  Following Paget, the microscope became the essential and indispensable scientific tool of pathology.  Paget published Lectures on Surgical Pathology, one of the two landmark works in pathology.  He served as surgeon extraordinary to Queen Victoria and surgeon in ordinary to the Prince of Wales, and was elected president of the Royal College of Surgeons.\n\nLeopold von Schroetter contemporaneously and independently studied and described venous TOS, but did not publish until 1884.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-13610\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"11\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-13610\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1884 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-13610\" class=\"elementor-element elementor-element-9e9fb5f e-con-full e-flex e-con e-child\" data-id=\"9e9fb5f\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-c15f103 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"c15f103\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Leopold-von-Schrotter-150x150-1.jpg\" class=\"attachment-full size-full wp-image-20717\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Leopold von Schroetter<\/h3><p class=\"elementor-image-box-description\">In Vienna, Leopold von Schroetter independently describes spontaneous thrombosis of the subclavian-axillary vein in young individuals.\n\nVon Schroetter was an internist and laryngologist in Vienna.  He developed the first modern lecture hall, with an accompanying laboratory. At the age of 78, he attended the Crown Prince of Germany.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-13611\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"12\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-13611\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1893 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-13611\" class=\"elementor-element elementor-element-66b2cc8 e-con-full e-flex e-con e-child\" data-id=\"66b2cc8\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-68afe54 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"68afe54\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Cervical-ribs-skiagram-150x150-1.jpg\" class=\"attachment-full size-full wp-image-20721\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">H. Lewis Jones<\/h3><p class=\"elementor-image-box-description\">In 1893, H. Lewis Jones described six patients with symmetric atrophy of hand muscles, usually preceded by pain and tingling. In 1906, he revisited these cases, along with additional cases he had seen since the original publication, and retrieved their x-rays. He found a strong correlation between symptoms and the presence of cervical ribs. In particular, he retrieved the records of 14 patients with pain and hand muscle atrophy. Of these 14, 10 had cervical ribs. 8 patients had bilateral symptoms and bilateral cervical ribs, and 2 had a unilateral cervical rib on the side of their symptoms.\n\nIn 1902, Farquhar Buzzard described 7 patients with brachial plexus involvement, at least one of which appears to have neurogenic TOS.\n\nIn 1903, Edwin F. Bramwell described an 18 year-old plumber with sensory and motor disturbances in his left arm. He found hand weakness and atrophy of intrinsic hand muscles. Bramwell described the abnormality as a \u201clesion of the first dorsal root.\u201d Bramwell proposed the \u2018sharp internal border of the first rib\u2019 had caused nerve trauma.\n\nNeither Buzzard nor Bramwell excluded cervical ribs in their patients.\n\nWhile Jones did recognize the pattern of neurogenic TOS in young women as early as 1893, he did not confirm the association with cervical ribs until 1906. In the meantime, Thorburn had recognized the same association, and had already treated neurogenic TOS patients through the removal of cervical ribs by 1904.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-13612\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"13\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-13612\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1895 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-13612\" class=\"elementor-element elementor-element-038ce82 e-con-full e-flex e-con e-child\" data-id=\"038ce82\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-8cb89d1 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"8cb89d1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/First-x-ray-Cropped-1-150x150-1.jpg\" class=\"attachment-full size-full wp-image-20722\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Wilhelm Conrad Roentgen<\/h3><p class=\"elementor-image-box-description\">In 1895, Wilhelm Conrad R\u00f6ntgen was working with cathode ray tubes when he discovered a novel type of electromagnetic radiation, which he called an \u201cx-ray.\u201d He noted that his body cast a strange image when he passed between the cathode ray tube and a barium-coated screen. After two weeks of experimentation, R\u00f6ntgen created the first radiograph or roentgenogram. This famous image shows his wife\u2019s hand with a ring.\n\nThe x-ray enabled doctors (and others) to see inside the living human for the first time, and became an international sensation. X-rays were used for many purposes, and in the setting of TOS made the diagnosis of cervical ribs easy and accurate. These images were known as \u2018skiagrams,\u2019 and became a standard part of the workup of patients presenting with vascular compression or aneurysm in the thoracic outlet.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-13613\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"14\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-13613\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1905 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-13613\" class=\"elementor-element elementor-element-8fd03ed e-con-full e-flex e-con e-child\" data-id=\"8fd03ed\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-90763e7 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"90763e7\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/John-Benjamin-Murphy-150x150-1.jpg\" class=\"attachment-full size-full wp-image-20726\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">John Benjamin Murphy<\/h3><p class=\"elementor-image-box-description\">John Benjamin Murphy of Chicago is the first surgeon to resect a cervical rib associated with a subclavian artery aneurysm.\n\nDr. Murphy is still known for numerous surgical innovations, including Murphy\u2019s button (to join two segments of bowel), Murphy\u2019s sign (for the diagnosis of cholecystitis), Murphy\u2019s tympani, and the Murphy test (for diagnosis of kidney disease). Dr. Murphy pioneered end-to-end anastomoses of hollow viscera and blood vessels, championed early appendectomy in cases of appendicitis (despite strong opposition from the Chicago medical establishment), and introduced therapeutic pneumothorax for pulmonary tuberculosis.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-13614\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"15\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-13614\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1907 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-13614\" class=\"elementor-element elementor-element-5f461a5 e-con-full e-flex e-con e-child\" data-id=\"5f461a5\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-f41391e elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"f41391e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/William-Keen-150x150-1.jpg\" class=\"attachment-full size-full wp-image-20733\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">William Williams Keen<\/h3><p class=\"elementor-image-box-description\">Dr. William Keen at Thomas Jefferson University in Philadelphia publishes a review of all 42 known cases of resected cervical ribs, and describes a clinical definition and surgical treatment for this disorder.\n\nDr. William Williams Keen became renowned as the first surgeon in America to remove a brain tumor and have the patient survive for 30 years. Dr. Keen had served as a surgeon in the Civil War, and utilized his experiences to publish the seminal book in its field, Gunshot Wounds and Other Injuries of the Nerves. \n\nAfter the Civil War, Dr. Keen traveled to Europe to study with famed physicians Duchenne in Paris and Virchow in Berlin.  Dr. Keen returned to Thomas Jefferson University in Philadelphia as professor of surgery, where he performed the first successful brain tumor removal, performed the first ventricular puncture for the treatment of hydrocephalus and increased intracranial pressure, and developed the technique of cervical nerve root section for the treatment of spasmodic torticollis.  In 1887, Dr. Keen revised and re-edited the American edition of Grey\u2019s anatomy, and in 1906 he became editor of the multivolume Surgery, Its Principles and Practice.  In this volume, Dr. Harvey Cushing, with whom Dr. Keen had a long professional relationship, first published work that created a sensation in the medical world, and established the discipline of neurosurgery as a distinct field in medicine.<br><h3>\n\nPhysician to Presidents <\/h3><br>\nIn 1893, Dr. Keen assisted in removing a sarcoma from the mouth of President Grover Cleveland, an operation which was kept secret for more than 15 years, until after the President\u2019s death.  In 1921, Dr. Keen attended Franklin Delano Roosevelt after he contracted polio.  Dr. Keen was the president of the American Medical Association in 1900, was the first surgeon to receive an honorary fellowship in the American College of Surgeons, was elected an honorary fellow of the Royal College of Surgeons in England and the Legion of Honor in France, and received honorary degrees from seven North American universities and four international universities.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-13615\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"16\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-13615\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1908 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-13615\" class=\"elementor-element elementor-element-660a15a e-con-full e-flex e-con e-child\" data-id=\"660a15a\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-b1aaf10 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"b1aaf10\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Cervical-Rib-Year-1901-150x150-1.jpg\" class=\"attachment-full size-full wp-image-20737\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">J. B. Roberts<\/h3><p class=\"elementor-image-box-description\">J. B. Roberts describes a series of different forms of cervical ribs, and proposes a surgical approach to each of these different forms.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-13616\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"17\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-13616\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1927 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-13616\" class=\"elementor-element elementor-element-e773e06 e-con-full e-flex e-con e-child\" data-id=\"e773e06\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-1b408d8 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"1b408d8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Alfred-Washington-Adson-150x150-1.jpg\" class=\"attachment-full size-full wp-image-20741\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Alfred Washington Adson and Jay R. Coffey<\/h3><p class=\"elementor-image-box-description\">Adson and Coffey at the Mayo Clinic suggest the mechanism by which the anterior scalene muscle causes neurovascular compression in patients with cervical ribs, and are the first to demonstrate that scalenotomy alone can relieve the symptoms of neurovascular compression, without resection of the cervical rib. This procedure becomes popular for several decades, although the recurrence rate is very high.\n\nDr. Alfred Washington Adson created and headed the Section of Neurological Surgery at the Mayo Clinic. He was a pioneer in American surgery, was a founding member and president of the Society of Neurological Surgeons, and was president of the Minnesota State Medical Association and the Minnesota State Board of Medical Examiners..\n\nDr. Alfred Washington Adson created and headed the Section of Neurological Surgery at the Mayo Clinic. He was a pioneer in American surgery, was a founding member of the Society of Neurological Surgeons, and was president of the Society of Neurological Surgeons, of the Minnesota State Medical Association, and the Minnesota State Board of Medical Examiners.\n\nIn 1938, Adson performed the first total anterior scalenectomy, removing the entire muscle.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-80be7b9 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"80be7b9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9d950e0 elementor-widget elementor-widget-heading\" data-id=\"9d950e0\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"oc_Cervical_Rib_Syndromes_without_a_Cervical_Rib\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Cervical Rib Syndromes without a Cervical Rib<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9e4a64f elementor-widget elementor-widget-text-editor\" data-id=\"9e4a64f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>After the advent of the\u00a0<a href=\"https:\/\/www.tosmri.com\/diagnosis-of-thoracic-outlet-syndrome\/imaging-diagnosis-of-thoracic-outlet-syndrome\/\">medical x-ray<\/a>, physicians thought they had solved the problem of the cervical rib syndrome. Patients with vascular or neurologic symptoms underwent an x-ray examination, and a cervical rib appeared. Shortly after this issue had resolved, a number of reports arose in the medical literature regarding patients with cervical rib syndrome, in whom x-rays demonstrated no cervical rib. Now these same physicians found they faced an entirely new challenge-\u2018cervical rib syndrome without a cervical rib\u2019 syndrome.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-74bfbb6 elementor-widget elementor-widget-n-accordion\" data-id=\"74bfbb6\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;default_state&quot;:&quot;all_collapsed&quot;,&quot;max_items_expended&quot;:&quot;one&quot;,&quot;n_accordion_animation_duration&quot;:{&quot;unit&quot;:&quot;ms&quot;,&quot;size&quot;:400,&quot;sizes&quot;:[]}}\" data-widget_type=\"nested-accordion.default\">\n\t\t\t\t\t\t\t<div class=\"e-n-accordion\" aria-label=\"Accordion. Open links with Enter or Space, close with Escape, and navigate with Arrow Keys\">\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-1220\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"1\" tabindex=\"0\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-1220\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1903 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-1220\" class=\"elementor-element elementor-element-03f0380 e-con-full e-flex e-con e-child\" data-id=\"03f0380\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-07ae192 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"07ae192\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Microcosmographia-Crooke-1615-150x150-1.jpg\" class=\"attachment-full size-full wp-image-20691\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\"> Edwin Bramwell and E. Farquhar Buzzard<\/h3><p class=\"elementor-image-box-description\">Bramwell describes the first case of neurogenic TOS without a cervical rib.\n\nAn 18 year-old plumber developed sensory and motor disturbances in his left arm. Bramwell found weakness, with atrophy of intrinsic hand muscles. He described the abnormality as a \u201clesion of the first dorsal root.\u201d Bramwell also proposed the \u2018sharp internal border of the first rib\u2019 had caused nerve trauma.\n\nBramwell also referred to several similar cases seen by Buzzard in 1902. Most of these cases appear to represent post-infectious neuropathy, although unusually limited to a single root. A final case noted in brief by Buzzard may, in fact, represent neurogenic TOS.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-1221\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"2\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-1221\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1904 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-1221\" class=\"elementor-element elementor-element-85ddbd1 e-con-full e-flex e-con e-child\" data-id=\"85ddbd1\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ae2199a elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"ae2199a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"300\" height=\"248\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Thorburn-1904-Cervical-Rib-Radiogram-300x248-1.jpg\" class=\"attachment-full size-full wp-image-20748\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">William Thorburn<\/h3><p class=\"elementor-image-box-description\">First surgical removal of a cervical rib.\n\nThorburn describes two young female patients with cervical ribs on X-ray, and corresponding unilateral symptoms of diminished pulse, pain, hand muscle atrophy and weakness, and temperature sensory abnormalities. He removed the cervical rib in each of these patients, with considerable reduction of symptoms.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-1222\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"3\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-1222\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1910 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-1222\" class=\"elementor-element elementor-element-8df2bcc e-con-full e-flex e-con e-child\" data-id=\"8df2bcc\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-c5ce1a1 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"c5ce1a1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Craig-Broad-Anterior-Scalene-Insertion-150x150-1.jpg\" class=\"attachment-full size-full wp-image-20749\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\"> Thomas Murphy<\/h3><p class=\"elementor-image-box-description\">Mr. Thomas Murphy, of Melbourne, Australia, performs the first resection of a normal first rib for the treatment of neurogenic thoracic outlet syndrome.\n\nThomas Murphy described a 28 year-old woman with symptoms of brachial plexus compression. X-rays showed no cervical rib, but Murphy was convinced the brachial plexus was compressed. Murphy performed surgery, finding the broad insertion of the anterior scalene was compressing the brachial plexus. He removed the insertion and a small part of the first rib. The patient had a \u201cperfect and permanent\u201d recovery.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-1223\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"4\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-1223\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1912 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-1223\" class=\"elementor-element elementor-element-15e01f4 e-con-full e-flex e-con e-child\" data-id=\"15e01f4\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-218db58 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"218db58\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Thomas-Wingate-Todd-150x150-1.jpg\" class=\"attachment-full size-full wp-image-20750\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Thomas Wingate Todd<\/h3><p class=\"elementor-image-box-description\">Thomas Wingate Todd at Manchester University describes the potential causes of neurovascular compression in the thoracic outlet in a series of scientific papers outlining the anatomy and anatomical variations of the thoracic outlet. Dr. Todd\u2019s anatomic dissections included descriptions of cervical ribs, anatomic variations of the first rib and scalene muscles, and the position of the clavicle with shoulder movements. Dr. Todd also postulated that the gradual descent of the shoulder girdle with aging causes narrowing of space between the clavicle and rib, contributing to neurovascular compression.\n\nHowever, Todd also describes in detail a distinct mechanism causing narrowing of only small, distal arteries. In 1912, he shows sympathetic nerve fibers passing from the T2 nerve root to the T1 nerve root variably in humans. In 1913, he demonstrates that pressure on sympathetic nerves causes narrowing and occlusion of small arteries.\n\nDr. Todd became Professor and Chairman of Anatomy at what is now Case Western Reserve University Medical School in Cleveland in 1912. Dr. Todd built the Hamann-Todd Osteological Collection, the world\u2019s largest collection of human and anthropoid skeletons. He also publishes The Atlas of Skeletal Maturation in 1937, and initiated the Brush study in 1926, both of which are widely-accepted tools for the evaluation of human skeletal growth and maturation.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-1224\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"5\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-1224\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1916 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-1224\" class=\"elementor-element elementor-element-70e8fec e-con-full e-flex e-con e-child\" data-id=\"70e8fec\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-03a0a4d elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"03a0a4d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Halsted-Color-150x150-1.jpg\" class=\"attachment-full size-full wp-image-20754\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">William Halsted<\/h3><p class=\"elementor-image-box-description\">William Halsted publishes an article reviewing the available knowledge regarding subclavian artery aneurysms associated with cervical ribs. He then tried to recreate and explain the mechanism.\n\nHalsted collated 716 cases of cervical ribs from the medical literature, and found 27 with subclavian artery aneurysms. He performed experiments on dogs, creating arterial constrictions of varying degrees for varying lengths of time until he reproduced an aneurysm appearing immediately distal to the constriction. Halsted then proposed a mechanism by which such aneurysm formation could occur.\n\nDr. 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 performs the first emergency blood transfusion, the first radical mastectomy, the first nerve block, the first inguinal hernia repair, and invents 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. He created subspecialty divisions in the surgery department, and the radiology department at Johns Hopkins. Dr. Halsted became renowned for training surgical residents, many of whom went on to create surgical residency programs at institutions throughout the United States, spreading the prodigious influence of Dr. Halsted. Dr. Halsted was also the captain of the first American 11-player football team in 1870.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-1225\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"6\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-1225\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1919 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-1225\" class=\"elementor-element elementor-element-1e2410e e-con-full e-flex e-con e-child\" data-id=\"1e2410e\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-2b525d5 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"2b525d5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/JSB-Stopford-150x150-1.jpg\" class=\"attachment-full size-full wp-image-20755\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">John Sebastian Bach Stopford and E. D. Telford<\/h3><p class=\"elementor-image-box-description\">John Sebastian Bach Stopford and E. D. Telford at Manchester University Medical School describe compression of the lower trunk of the brachial plexus by a normal first rib, and report results from 10 patients following resection of the first rib.\n\nStopford and Telford considered the following three key elements as the underlying etiologic factors in development of brachial plexus compression:<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e63af13 elementor-widget elementor-widget-text-editor\" data-id=\"e63af13\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<ul class=\"custom-arrow\">\n\n  <li>\n    Anatomical relationship of the brachial plexus and the first rib, including anatomic variations of the first rib\n  <\/li>\n\n  <li>\n    Gradual descent of the shoulder from childhood to adulthood\n  <\/li>\n\n  <li>\n    Strength and tone of the supporting muscles of the shoulder\n  <\/li>\n\n<\/ul>\n\n<div class=\"fusion-text\">\n\n  <p>\n    Stopford and Telford reported the first case of a patient with neurogenic symptoms and a cervical rib, in whom successful treatment was performed by resection of the normal first rib, leaving the cervical rib in place.\n  <\/p>\n\n  <p>\n    John Sebastian Bach Stopford trained under Thomas Wingate Todd, and wrote numerous scientific papers on the traumatic disruption of nerves, the regeneration of injured nerves, the autonomic nervous system, and the compression of peripheral nerves, most notably that caused by cervical ribs.\n  <\/p>\n\n  <p>\n    Dr. Stopford\u2019s monograph on the circulation of the pons and medulla is regarded as a classic publication. Later in his career, Dr. Stopford served as the Chair of Anatomy, the Dean of the medical school, and the Vice-Chancellor of the University.\n  <\/p>\n\n  <p>\n    Dr. Stopford was appointed M.B.E. and K.B.E., was knighted in 1941, was awarded honorary degrees in science and law at the University of Cambridge and other universities, and was awarded Honorary Fellowships in the Royal College of Surgeons and the Royal College of Physicians.\n  <\/p>\n\n  <p>\n    Stopford and Telford made further contributions to our knowledge of TOS. Please see their additional timeline entry for 1931.\n  <\/p>\n\n<\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-1226\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"7\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-1226\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1920 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-1226\" class=\"elementor-element elementor-element-bb1684d e-con-full e-flex e-con e-child\" data-id=\"bb1684d\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-021de30 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"021de30\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Law-Ligaments-2-150x150-1.jpg\" class=\"attachment-full size-full wp-image-20759\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Arthur Ayer Law<\/h3><p class=\"elementor-image-box-description\">Dr. Arthur Ayer Law demonstrates the existence of several soft tissue bands that cause neurovascular compression, simulating a cervical rib.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-1227\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"8\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-1227\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1927 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-1227\" class=\"elementor-element elementor-element-aa502d4 e-con-full e-flex e-con e-child\" data-id=\"aa502d4\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7840799 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"7840799\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Cervical-Rib-Diagram-3-Adson-Cropped-150x150-1.jpg\" class=\"attachment-full size-full wp-image-20763\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Gould, Symonds, Yates and Guest<\/h3><p class=\"elementor-image-box-description\">First cases of stroke caused by arterial TOS.\n\nGould described a 19 year-old laborer who had pain, weakness and coldness of his right hand. Gould found a cervical rib on examination, and he could create turbulence within the adjacent subclavian artery by pressing on it. Years later, the right arm pulse disappeared and weakness appeared in the left arm (likely due to stroke).\n\nIn 1927, C.P. Symonds described two patients presenting with left-sided weakness, who also had right-sided cervical ribs and arterial TOS. Dr. Symonds proposed a mechanism tying the two processes together. Symonds suggested that the cervical rib caused damage to the right subclavian artery, resulting in blood clot formation. This blood clot extended proximally towards the heart until it entered the right common carotid artery. At this point, clot fragments broke off and traveled to the brain, causing stroke.\n\nNeither author provided pathologic proof in these patients, although Symonds confirmed cervical ribs with x-rays.\n\nIn 1928, Yates and Guest described a patient with a non-united right clavicle fracture, loss of pulses and weakness. The patient suffered a stroke which resulted in their death. Autopsy showed the following:<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6c85f38 elementor-widget elementor-widget-text-editor\" data-id=\"6c85f38\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<ul class=\"custom-arrow\">\n\n  <li>Fracture fragments pressing on the subclavian artery<\/li>\n\n  <li>Blood clot within this segment of the subclavian artery<\/li>\n\n  <li>Proximal growth of the blood clot towards the heart, close to the common carotid artery<\/li>\n\n  <li>Embolus in the distal basilar artery<\/li>\n\n<\/ul>\n\n<div class=\"fusion-separator fusion-full-width-sep\"><\/div>\n\n<div class=\"fusion-text\">\n  <p>\n    This case provided pathologic proof of the process proposed by Symonds.\n  <\/p>\n<\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-1228\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"9\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-1228\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1929 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-1228\" class=\"elementor-element elementor-element-0fc5f99 e-con-full e-flex e-con e-child\" data-id=\"0fc5f99\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-b85343b elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"b85343b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Howard-Naffziger-2-150x150-1.jpg\" class=\"attachment-full size-full wp-image-20764\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Howard Christian Naffziger and Francis Clark Grant<\/h3><p class=\"elementor-image-box-description\">Naffziger and Grant first introduce the concept of neurovascular compression in the thoracic outlet due to scalene muscle anomalies, without the presence of a cervical rib. They perform the first scalenotomies in patients without cervical ribs, but do not publish their findings until 1937 and 1938.\n\nDr. 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 the 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.\n\nFrancis Clark Grant trained under eminent neurosurgeons Charles Frazier and Harvey Cushing. Dr. Grant succeeded Dr. Frazier as Professor and Chairman of Neurosurgery at the School of Medicine and the University Hospital at University of Pennsylvania. He published over 200 papers in his lifetime, and refined or developed several neurosurgical procedures and instruments.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-1229\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"10\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-1229\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1931 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-1229\" class=\"elementor-element elementor-element-4e5c79b e-con-full e-flex e-con e-child\" data-id=\"4e5c79b\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-abb39e2 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"abb39e2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"248\" height=\"200\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Stopford-Telford-Sympathetic-Variants.jpg\" class=\"attachment-full size-full wp-image-20768\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">John Sebastian Bach Stopford and E. D. Telford<\/h3><p class=\"elementor-image-box-description\">Stopford and Telford describe a new mechanism of arterial occlusion caused by nerve pressure in the thoracic outlet, without involvement of the subclavian artery. They describe three patients with severe arterial occlusion and distal gangrene of the fingers and hand. Each of these patients had a cervical rib, but no subclavian artery compression or aneurysm. And, in each patient, removal of the cervical rib provides complete relief of symptoms.\n\nSpecifically, Stopford and Telford explain how sympathetic fibers of the lower brachial plexus regulate the small arteries of the arm and hand. Considering prior work by Wingate, they demonstrate how some patients have variable anatomy of these fibers, immediately adjacent to the first rib. Thus, pressure by the first rib, or a cervical rib, in some patients causes abnormal regulation of the small arteries. As a result, these arteries constrict over a long period of time. At first, the patients experience pallor and coldness from loss of arterial blood flow. Over time, the lining of the arteries expands, blocking arterial flow. This results in gangrene, or loss of tissue.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-12210\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"11\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-12210\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1935 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-12210\" class=\"elementor-element elementor-element-7ab306b e-con-full e-flex e-con e-child\" data-id=\"7ab306b\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3e8f951 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"3e8f951\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Michael_E._DeBakey-150x150-1.jpg\" class=\"attachment-full size-full wp-image-20769\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Alton Ochsner, Mims Gage and Michael DeBakey<\/h3><p class=\"elementor-image-box-description\">Renowned surgeons Alton Ochsner, Mims Gage and Michael DeBakey at LSU publish a comprehensive study of patients with symptoms of neurovascular compression in the thoracic outlet in the absence of a cervical rib, for which they coin the term, \u201cScalenus Anticus Syndrome\u201d. They credit Naffziger with first recognizing this mechanism in 1929 in patients without cervical ribs, and suggest the term \u201cNaffziger Syndrome\u201d.\n\nDr. 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.\n\nDr. Michael DeBakey is one of the most renowned cardiovascular surgeons in the world. After volunteering for military service in World War II, Dr. DeBakey created the concept of the Mobile Army Surgical Hospital (M*A*S*H unit) that enjoyed 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 to and innovations in cardiovascular surgery, including work on the Dacron artificial graft, the heart-lung machine, and the artificial heart.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-12211\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"12\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-12211\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1938 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-12211\" class=\"elementor-element elementor-element-5eb014b e-con-full e-flex e-con e-child\" data-id=\"5eb014b\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-69f1205 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"69f1205\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"304\" height=\"200\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Adson-Scalenotomy-1.jpg\" class=\"attachment-full size-full wp-image-20773\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Alfred Washington Adson<\/h3><p class=\"elementor-image-box-description\">Adson performs the first scalenectomy, or resection of the entire anterior scalene muscle. This procedure is then performed intermittently over the next several decades, until Sanders introduces a more refined technique in 1979.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-12212\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"13\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-12212\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1939 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-12212\" class=\"elementor-element elementor-element-eedd21c e-con-full e-flex e-con e-child\" data-id=\"eedd21c\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ae039c7 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"ae039c7\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"250\" height=\"250\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Telford-Mottershead.jpg\" class=\"attachment-full size-full wp-image-20777\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Kenneth C. Eden<\/h3><p class=\"elementor-image-box-description\">In 1939, Eden first demonstrated the role of the clavicle in TOS.\n\nEden operated on three patients with aneurysm or occlusion of the subclavian artery; two with a cervical rib, and one without. At surgery, he demonstrated marked narrowing of the space below the clavicle on arm motion. In patients with a cervical rib or a normal first rib, arterial damage occurred in this narrowed space.\n\nEden stated, \u201cThe findings in these three cases suggest that the wall of the subclavian artery is weakened by intermittent compression by the clavicle against a bony obstruction. This is usually provided by\u2026a complete cervical rib, but an abnormal first thoracic rib may do so also.\u201d<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-12213\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"14\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-12213\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1943 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-12213\" class=\"elementor-element elementor-element-abdf26d e-con-full e-flex e-con e-child\" data-id=\"abdf26d\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-31360e6 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"31360e6\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"200\" height=\"250\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Murray-Falconer-200x250-1.jpg\" class=\"attachment-full size-full wp-image-20781\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Murray Falconer and Graham Weddell<\/h3><p class=\"elementor-image-box-description\">Murray Falconer and Graham Weddell describe military recruits with neurovascular compression.  These recruits experience symptoms while carrying heavy backpacks or assuming the \u201cmilitary\u201d position, with the shoulders thrust backwards. Falconer and Weddell propose that the weight depresses the shoulders and causes neurovascular compression between the normal clavicle and first rib. Falconer and Weddell coin the term \u201ccostoclavicular syndrome\u201d. Note that Eden first considered this mechanism in 1939.\n\nControversy about the existence of costoclavicular syndrome developed. In 1962, Falconer and Dr. Franklin W. P. Li described a series of 11 patients who underwent  first rib resection with good results. Falconer and Li felt that the success of their approach confirmed the mechanism of costoclavicular syndrome. Several of these patients had been previously unsuccessfully treated for carpal tunnel syndrome.\n\nDr. Falconer was one of the strongest proponents for the use of surgical ablation in the treatment of temporal lobe epilepsy.  He performed a fellowship under pioneer neurosurgeon Alfred Adson at the Mayo clinic in 1937, and was named first Director of Neurosurgery at Guy\u2019s Hospital in London in 1949. Dr. Falconer developed the renowned program at this institution for the treatment of temporal lobe epilepsy, and over his career helped to elucidate the pathology of temporal lobe epilepsy, and developed and refined the surgical criteria and techniques for treatment of patients with this condition.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-12214\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"15\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-12214\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1944 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-12214\" class=\"elementor-element elementor-element-29a1b2b e-con-full e-flex e-con e-child\" data-id=\"29a1b2b\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-dba1afc elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"dba1afc\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"250\" height=\"250\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Swank-Upper-vs-Lower-BP-TOS.jpg\" class=\"attachment-full size-full wp-image-20788\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">R. L. Swank<\/h3><p class=\"elementor-image-box-description\">R. L. Swank first describes the differences between upper and lower brachial plexus involvement in thoracic outlet syndrome.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-12215\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"16\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-12215\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1945 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-12215\" class=\"elementor-element elementor-element-d57948c e-con-full e-flex e-con e-child\" data-id=\"d57948c\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-46f3bc7 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"46f3bc7\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"400\" height=\"328\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Irving-Wright-1955-400x328-1.jpg\" class=\"attachment-full size-full wp-image-20795\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Irving S. Wright<\/h3><p class=\"elementor-image-box-description\">Irving S. Wright describes patients with similar symptoms and signs as those with \u2018costoclavicular syndrome.\u2019 However, Wright\u2019s patients experience symptoms with hyperabduction of the arms (elevation of the arms above the head). Interestingly, Wright could not reproduce symptoms or pulse obliteration in his patients by using the maneuvers used by Falconer.\n\nWright went on to test 150 asymptomatic volunteers by performing hyperabduction of their arms while monitoring their pulse. In nearly 90% of volunteers, Wright induced obliteration of the radial pulse, despite the volunteers having no symptoms. In only two of the 150 patients could Wright induce tingling, presumed to represent nerve compression. Interestingly, neither of these patients had a loss of pulse in the same arm position. Wright concluded that clinical obliteration of the pulse was not correlated with compression of the brachial plexus.\n\nWright also performed anatomic dissections to further understand the underlying mechanism of hyperabduction. He proposed that there were two different mechanisms, which might occur in isolation or in combination in different patients. First, Wright proposed that the space posterior to the pectoralis minor muscle would create \u201cstretching, torsion, and pinching\u201d of the vessels and brachial plexus only in hyperabduction. Second, he proposed that different arm motions, as demonstrated by Eden in 1939 and Falconer in 1943, would cause similar changes between the clavicle and the first rib.\n\nFinally, Wright suggests that these mechanical factors cause two different types of pathologic process: \u201cThe stretching or pinching of the nerve trunks probably produces the immediate paresthesias. Ischemia due to impaired blood supply to the nerves may play a part after prolonged hyperabduction.\u201d<br>\n\n<h3>A Recognized Pioneer<\/h3><br>\nDr. Wright is known as a pioneer in the treatment of blood clots. Blood clots in the legs can break off and lodge in the lungs. These pulmonary emboli may be fatal. Heart attacks are caused by blood clots in the coronary arteries. Dr. Wright had suffered months of severe blood clots in his 30s. After recovering, he used an experimental drug called Heparin to successfully treat a patient with similar disease. Dr. Wright was awarded the prestigious Albert Lasker Award from the American Heart Association in 1960, recognizing his study of Heparin use in 800 patients with heart attacks. Dr. Wright served as president of the American Heart Association, the American College of Physicians and the American Geriatric Society.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-12216\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"17\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-12216\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1953 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-12216\" class=\"elementor-element elementor-element-cc66365 e-con-full e-flex e-con e-child\" data-id=\"cc66365\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4b11218 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"4b11218\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"200\" height=\"250\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Clavicles-ribs-brachial-plexus-anatomy.jpg\" class=\"attachment-full size-full wp-image-20799\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Jere Lord<\/h3><p class=\"elementor-image-box-description\">Dr. Jere W. Lord performs the first claviculectomy (removal of the clavicle). Lord aims to relieve compression of the neurovascular bundle in the costoclavicular interval.  Unfortunately, many authorities consider this procedure cosmetically disfiguring, and feel it causes a significant alteration in function, and it never becomes popular.\n\nDr. Lord was a professor of clinical surgery at New York University School of Medicine, a present of the New York Heart Association, and he published over 180 papers in the academic literature.\n\nDr. Lord referred to Telford and Mottershead in 1948, and stated, \u201cIf one analyzes the anatomical structures through which the subclavian and axillary artery and vein must pass, then it is evident that no single operative procedure can be successful in all cases of the shoulder girdle syndromes.\u201d This prescient statement remains pertinent today.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-12217\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"18\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-12217\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1956 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-12217\" class=\"elementor-element elementor-element-e284757 e-con-full e-flex e-con e-child\" data-id=\"e284757\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-389cefd elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"389cefd\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"233\" height=\"250\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Lord-Stone-Pec-Minor-Tenotomy.jpg\" class=\"attachment-full size-full wp-image-20800\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Jere Lord and Peter Stone<\/h3><p class=\"elementor-image-box-description\">Lord and Stone publish the first report on pectoralis minor tenotomy.\n\nThey perform pectoralis minor tenotomy in addition to anterior scalenectomy in 5 patients, with good results in 4 patients<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ab834a2 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"ab834a2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b4beae7 elementor-widget elementor-widget-heading\" data-id=\"b4beae7\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Treatment of Venous Thoracic Outlet Syndrome\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3838b85 elementor-widget elementor-widget-text-editor\" data-id=\"3838b85\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-9\"><p>Critical treatment decisions center around removal of the venous blood clot in the arm. Severe or total\u00a0<a href=\"https:\/\/www.tosmri.com\/treatment-of-thoracic-outlet-syndrome\/treatment-of-venous-thoracic-outlet-syndrome\/\">venous occlusion demands urgent treatment<\/a>. After doctors remove the venous blood clot in the arm, they are able to address the underlying causes of vein compression and damage. Click through to learn more about the treatment of venous thoracic outlet syndrome.<\/p><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-be9c256 elementor-widget elementor-widget-button\" data-id=\"be9c256\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"https:\/\/hlsllc.org\/tos\/treatment-of-venous-tos\/\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\"> Treatment of Venous Thoracic Outlet Syndrome<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-657c734 e-con-full e-flex e-con e-parent\" data-id=\"657c734\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-67274b8 elementor-widget elementor-widget-heading\" data-id=\"67274b8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Do you have questions about thoracic outlet syndrome?\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a680605 elementor-widget elementor-widget-heading\" data-id=\"a680605\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">We can help!\n\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fee63f8 elementor-widget elementor-widget-button\" data-id=\"fee63f8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"#\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Contact us<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-8b9d2d8 e-con-full e-flex e-con e-parent\" data-id=\"8b9d2d8\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-18f5969 e-con-full e-flex e-con e-child\" data-id=\"18f5969\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-8715ae0 elementor-widget elementor-widget-heading\" data-id=\"8715ae0\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_Unification_ofThoracic_Outlet_Syndromes_and_the_Modern_TOS\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Unification of Thoracic Outlet Syndromes and the Modern TOS Era\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2d3f5e7 elementor-widget elementor-widget-text-editor\" data-id=\"2d3f5e7\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>As researchers and anatomists learned about the numerous anatomic variations and\u00a0<a href=\"https:\/\/www.tosmri.com\/what-is-thoracic-outlet-syndrome\/causes-of-thoracic-outlet-syndrome\/\">causes of thoracic outlet syndrome<\/a>, it became apparent that many patients suffered from related but different clinical syndromes.\u00a0A number of authors published articles regarding these syndromes, along with a number of different\u00a0<a href=\"https:\/\/www.tosmri.com\/diagnosis-of-thoracic-outlet-syndrome\/clinical-diagnosis-of-thoracic-outlet-syndrome\/clinical-diagnosis-of-neurogenic-thoracic-outlet-syndrome\/\">provocative maneuvers<\/a>. In 1956, Peet created an umbrella term to encompass all of these variable syndromes, and \u2018thoracic outlet syndrome\u2019 was born.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4b4ac03 elementor-widget elementor-widget-n-accordion\" data-id=\"4b4ac03\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;default_state&quot;:&quot;all_collapsed&quot;,&quot;max_items_expended&quot;:&quot;one&quot;,&quot;n_accordion_animation_duration&quot;:{&quot;unit&quot;:&quot;ms&quot;,&quot;size&quot;:400,&quot;sizes&quot;:[]}}\" data-widget_type=\"nested-accordion.default\">\n\t\t\t\t\t\t\t<div class=\"e-n-accordion\" aria-label=\"Accordion. Open links with Enter or Space, close with Escape, and navigate with Arrow Keys\">\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-7890\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"1\" tabindex=\"0\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-7890\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1956 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-7890\" class=\"elementor-element elementor-element-dcdf477 e-con-full e-flex e-con e-child\" data-id=\"dcdf477\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-bf36525 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"bf36525\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"250\" height=\"222\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/TOS-AP-Cropped-Final.jpg\" class=\"attachment-full size-full wp-image-20813\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\"> R. M. Peet<\/h3><p class=\"elementor-image-box-description\">R. M. Peet and colleagues first use the term \u201cthoracic-outlet syndrome\u201d to unify the large number of upper extremity neurovascular compression syndromes.\n\nIn 1958, Rob and Standeven describe a series of patients with cervical ribs, arterial thromboses or emboli, and distal gangrene of the upper extremity. They use the term, \u201cthoracic outlet compression syndrome\u201d for the first time.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-7891\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"2\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-7891\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1962 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-7891\" class=\"elementor-element elementor-element-35aa175 e-con-full e-flex e-con e-child\" data-id=\"35aa175\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-843bdc0 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"843bdc0\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/O-Theron-Clagett-150x150-1.jpg\" class=\"attachment-full size-full wp-image-20817\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">O. Theron Claggett<\/h3><p class=\"elementor-image-box-description\">O. Theron Claggett, the president of the American Association for Thoracic Surgery, and one of the premiere thoracic surgeons of the mid-twentieth century, re-introduces the first rib resection after decades of disappointing results from scalenotomy alone. In his presidential speech to the American Association for Thoracic Surgery, Claggett recounts an extensive history of TOS, and proposes first rib resection by the posterior approach. This posterior approach eventually falls out of favor because it requires a fairly radical soft-tissue dissection, and because it creates disruption of the posterior shoulder girdle musculature, which is now felt to be important in the stability of the shoulder girdle.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-7892\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"3\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-7892\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1960s <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-7892\" class=\"elementor-element elementor-element-fd1ed81 e-con-full e-flex e-con e-child\" data-id=\"fd1ed81\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ac87d82 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"ac87d82\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"250\" height=\"211\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Gray808.jpg\" class=\"attachment-full size-full wp-image-20818\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">1960s<\/h3><p class=\"elementor-image-box-description\">A number of authors publish descriptions of supraclavicular and infraclavicular approaches for first rib resection, but these approaches are not widely accepted.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-7893\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"4\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-7893\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1966 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-7893\" class=\"elementor-element elementor-element-8fd10ac e-con-full e-flex e-con e-child\" data-id=\"8fd10ac\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-efd98d8 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"efd98d8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"200\" height=\"250\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Roos-Transaxillary.jpg\" class=\"attachment-full size-full wp-image-20822\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">David Roos<\/h3><p class=\"elementor-image-box-description\">Dr. David Roos performs the first transaxillary first rib resection. Dr. Roos demonstrates and categorizes numerous soft tissue anomalies in the thoracic outlet. His transaxillary approach goes on to achieve wide acceptance, due to a less radical soft-tissue dissection than previous approaches, and to improved visualization of the muscular and fibrous anomalies that are known to exist in the thoracic outlet.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-7894\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"5\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-7894\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1972 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-7894\" class=\"elementor-element elementor-element-e7990b3 e-con-full e-flex e-con e-child\" data-id=\"e7990b3\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ebbe93f elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"ebbe93f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"200\" height=\"250\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Pectoralis-Minor-Model.jpg\" class=\"attachment-full size-full wp-image-20826\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">D. Silver and Chandu Vemuri<\/h3><p class=\"elementor-image-box-description\">D. Silver recommends tenotomy of the pectoralis minor in selected cases of first rib resection. Vemuri et al suggest that a population of  neurogenic TOS patients have predominant compression of the brachial plexus in the retropectoralis space. Thus, these authors suggest pectoralis minor tenotomy, either isolated or as an adjunct to first rib resection.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-7895\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"6\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-7895\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1979 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-7895\" class=\"elementor-element elementor-element-5225cba e-con-full e-flex e-con e-child\" data-id=\"5225cba\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d0ef995 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"d0ef995\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"200\" height=\"250\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Gray385-Scalene-Triangle.jpg\" class=\"attachment-full size-full wp-image-20830\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Richard Sanders<\/h3><p class=\"elementor-image-box-description\">Dr. Richard Sanders introduces supraclavicular scalenectomy in patients with recurrent symptoms following first rib resection for post-traumatic TOS. Due to the great success of this approach, Sanders subsequently utilizes scalenectomy as a primary approach in patients with TOS due to neck trauma.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-7896\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"7\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-7896\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1986 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-7896\" class=\"elementor-element elementor-element-5bf7cc4 e-con-full e-flex e-con e-child\" data-id=\"5bf7cc4\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4a7fb48 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"4a7fb48\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"300\" height=\"169\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Microscopy-Muscle-Fibers.jpg\" class=\"attachment-full size-full wp-image-20834\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Machleder, Moll, and Verity<\/h3><p class=\"elementor-image-box-description\">First histologic examination of the anterior scalene muscle.\n\nMachleder, Moll and Verity demonstrate microscopic transformation of the anterior scalene muscle in patients with TOS. They find an increase in the muscle fibers that cause slow-twitch, prolonged contraction, with concomitant loss of fast-twitch muscle fibers. This result suggest that the anterior scalene muscle has adapted to maintain higher levels of tension over a prolonged period.\n\nIn 1990, Sanders publishes another study of scalene muscle structure. Patients with traumatic TOS had abnormal scalene muscles, but other neck muscles were normal. Sanders confirmed the change in muscle fiber types noted by Machleder, et al. However, Sanders also found a considerable increase in fibrous tissue in the abnormal scalene muscles. He suggested that this process resulted in a less flexible anterior scalene muscle, whose fibrous edges might \u201cirritate nerves and produce neurologic symptoms, particularly in persons with anatomic predispositions to TOS.\u201d<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-7897\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"8\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-7897\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1989 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-7897\" class=\"elementor-element elementor-element-d9473fd e-con-full e-flex e-con e-child\" data-id=\"d9473fd\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-39edac8 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"39edac8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"268\" height=\"200\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Kryski-Retropectoralis-Space.jpg\" class=\"attachment-full size-full wp-image-20838\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Erdogan Atasoy<\/h3><p class=\"elementor-image-box-description\">Dr. Erdogan Atasoy performs transaxillary first rib resection combined with supraclavicular scalenectomy.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-7898\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"9\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-7898\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> 1992 <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-7898\" class=\"elementor-element elementor-element-51bfd81 e-con-full e-flex e-con e-child\" data-id=\"51bfd81\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-0f75501 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"0f75501\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"269\" height=\"200\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Makhoul-Machleder-Anatomic-Variations.jpg\" class=\"attachment-full size-full wp-image-20842\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Makhoul and Machleder<\/h3><p class=\"elementor-image-box-description\">Makhoul and Machleder demonstrate numerous anatomic variations in patients undergoing TOS surgery. They find anatomic variations in 2\/3 of surgical patients. Anatomic variations include cervical ribs, extra muscles, and variations of otherwise normal muscles. The variants are more common in these TOS patients than in normal subjects.\n\nMakhoul and Machleder make several important points. Firstly,  severe compression by these structures causes \u201cclassic\u201d cases, including venous thrombosis or arterial thrombosis or embolism. Second, less severe compression occurs, with symptoms brought on by recreational or occupational activity. Third, the artery and vein have \u201cresilience,\u201d and are less likely to be symptomatically compressed. The brachial plexus, on the other hand, is more sensitive to compression, and the threshold for neurogenic symptoms is lower. Finally, they believed that multiple factors contribute to the development of TOS:<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-32a873d elementor-widget elementor-widget-text-editor\" data-id=\"32a873d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<ul class=\"custom-arrow\">\n\n  <li>Anatomic variations<\/li>\n\n  <li>Gradual descent of the shoulder with maturation<\/li>\n\n  <li>Intrinsic cellular changes of the anterior scalene muscle caused by trauma<\/li>\n\n  <li>Increased functional requirements of the arm<\/li>\n\n<\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-29ceb6a elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"29ceb6a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-61065e5 elementor-widget elementor-widget-heading\" data-id=\"61065e5\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_Future_Directions_of_TOS\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Future Directions of TOS<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-38770e0 elementor-widget elementor-widget-text-editor\" data-id=\"38770e0\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>After reading the history of thoracic outlet syndrome, nobody would blame you if you were confused about\u00a0the complex history of thoracic outlet syndrome. And while much of the confusion has been clarified, a lot of this story remains to be told. Certainly, diagnosis and treatment of TOS has improved considerably over the past 200 years. At the same time, a lot of\u00a0<a href=\"https:\/\/www.tosmri.com\/diagnosis-of-thoracic-outlet-syndrome\/find-a-thoracic-outlet-syndrome-specialist\/\">thoracic outlet syndrome specialists<\/a>\u00a0in all corners of the country are actively seeking new methods of diagnosis and treatment for patients with TOS. Read here about some of\u00a0the new directions that are just blossoming.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-906adda elementor-widget elementor-widget-n-accordion\" data-id=\"906adda\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;default_state&quot;:&quot;all_collapsed&quot;,&quot;max_items_expended&quot;:&quot;one&quot;,&quot;n_accordion_animation_duration&quot;:{&quot;unit&quot;:&quot;ms&quot;,&quot;size&quot;:400,&quot;sizes&quot;:[]}}\" data-widget_type=\"nested-accordion.default\">\n\t\t\t\t\t\t\t<div class=\"e-n-accordion\" aria-label=\"Accordion. Open links with Enter or Space, close with Escape, and navigate with Arrow Keys\">\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-1510\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"1\" tabindex=\"0\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-1510\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> Orthotics <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-1510\" class=\"elementor-element elementor-element-2455502 e-con-full e-flex e-con e-child\" data-id=\"2455502\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-9f54cfd elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"9f54cfd\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Microcosmographia-Crooke-1615-150x150-1.jpg\" class=\"attachment-full size-full wp-image-20691\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><p class=\"elementor-image-box-description\">TOS patients know quite well that certain positions cause or increase symptoms. Therefore, it is natural that a number of people have developed orthotic devices to help patients maintain healthy ergonomic positions, or to retrain patients\u2019 posture and limb positions.\n\nOne such device is the BodyBuoy\u00ae vest developed by Dr. Tracy Newkirk, in Northern California. Dr. Newkirk has treated TOS patients for over thirty years, and has learned how to perform in-office repositioning to reduce symptoms. Over the past decade, Dr. Newkirk has developed and refined the BodyBuoy\u00ae orthotic vest that accomplishes the same effect while patients recover at home or at work.\n\nThe device is customized for each patient, and is highly adjustable to allow continued modification and improvement over time.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-1511\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"2\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-1511\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> Refinement of current surgical techniques <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-1511\" class=\"elementor-element elementor-element-7d47602 e-con-full e-flex e-con e-child\" data-id=\"7d47602\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4088bee elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"4088bee\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"200\" height=\"250\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/O-Theron-Clagett-200x250-1.jpg\" class=\"attachment-full size-full wp-image-20849\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><p class=\"elementor-image-box-description\">Patients who decide to undergo surgical treatment of TOS have new choices in surgical techniques.\n\nTraditional surgical approaches have included supraclavicular, infraclavicular, posterior and transaxillary approaches. Without delving into the details of each procedure, patients should know that each technique has advantages and disadvantages. In the absence of a gold standard for the diagnosis of TOS, most surgical outcome studies rely on pain scales and quality of life reported by patients. However, given what we know about the diversity of forms of TOS, the anatomic complexity of the thoracic outlet, and potential surgical complications, there is no consensus on the \u2018best\u2019 surgical approach for any single patient with TOS.\n\nFortunately, there are a number of experienced surgeons who have been performing the most widely-accepted surgical procedures for decades. Equally fortunately, there are a number of surgeons who are pioneering new techniques. These new techniques hold the potential for shorter surgery, less invasive surgery, fewer complications, and better outcomes.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-1512\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"3\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-1512\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> Robotic Surgery <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-1512\" class=\"elementor-element elementor-element-fb63f3a e-con-full e-flex e-con e-child\" data-id=\"fb63f3a\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-43810d9 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"43810d9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"250\" height=\"211\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Gray808-1.jpg\" class=\"attachment-full size-full wp-image-20853\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><p class=\"elementor-image-box-description\">Modern medicine benefits from our age of amazing technological advances. Surgeons are now able to view and operate on the thoracic outlet through tiny incisions, with the use of robotic surgical devices. Dr. Farid Gharagozloo, at Celebration Hospital in Orlando, Florida, is one such pioneer. Dr. Gharagozloo has developed and refined an approach to the first rib, from below, using the da Vinci\u00ae Surgical System. Dr. Gharagozloo has extensive experience, and has reported excellent outcomes through this approach. His approach avoids many of the potential complications of older, more traditional approaches to this complex anatomic region, and holds great promise for the future of TOS surgery.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-1513\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"4\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-1513\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> Peripheral nerve surgery <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-1513\" class=\"elementor-element elementor-element-167cc92 e-con-full e-flex e-con e-child\" data-id=\"167cc92\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7024824 elementor-position-left elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"7024824\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><img loading=\"lazy\" decoding=\"async\" width=\"200\" height=\"250\" src=\"https:\/\/hlsllc.org\/tos\/wp-content\/uploads\/2026\/04\/Roos-Transaxillary-1.jpg\" class=\"attachment-full size-full wp-image-20854\" alt=\"\" \/><\/figure><div class=\"elementor-image-box-content\"><p class=\"elementor-image-box-description\">Many plastic surgeons specialize in peripheral nerve surgery. These surgeons diagnose and treat patients who develop entrapment of small nerves throughout the body. The surgeons have highly-detailed knowledge of nerve anatomy, and perform very detailed dissections of the surrounding tissues to free up the trapped nerves.\n\nGiven the anatomic complexity of the thoracic outlet, peripheral nerve surgeons are well-equipped to address entrapment of the brachial plexus with minimal surgery, as well as dedicated injections guided by ultrasound.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-1514\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"5\" tabindex=\"-1\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-1514\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> Pectoralis Minor Tenotomy <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-plus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H272V64c0-17.67-14.33-32-32-32h-32c-17.67 0-32 14.33-32 32v144H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h144v144c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32V304h144c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-1514\" class=\"elementor-element elementor-element-fe23d9a e-con-full e-flex e-con e-child\" data-id=\"fe23d9a\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-f24e7fc elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"f24e7fc\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><div class=\"elementor-image-box-content\"><p class=\"elementor-image-box-description\">The pectoralis minor muscle arises from the anterior aspects of ribs 2 through 4, heads superiorly, and inserts on the coracoid process of the scapula. It acts to pull the scapula forward and down. This muscle also forms the anterior border of the retropectoralis space. Pectoralis minor tenotomy involves releasing it from its attachment on the scapula.\n\nAlthough tenotomy first introduced by Lord in 1956, the procedure did not become popular. Pectoralis minor tenotomy has been revived and popularized in the past 10 years. Some surgeons perform this procedure if a larger supraclavicular decompression and first rib resection fails. Other doctors consider this procedure as a primary treatment in some patients.\n\nMany doctors believe that the pectoralis minor muscle compresses the brachial plexus in some patients with neurogenic TOS. However, there are studies and there is anatomic data that contradicts this belief. Nonetheless, as the procedure gains popularity, further discussion is increasing our knowledge about this muscle.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3dfccb6 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"3dfccb6\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9c440a5 elementor-widget elementor-widget-heading\" data-id=\"9c440a5\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_History_of_the_name_Thoracic_Outlet_Syndrome\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">History of the name \u2018Thoracic Outlet Syndrome\u2019<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2e91f1e elementor-widget elementor-widget-text-editor\" data-id=\"2e91f1e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-9\"><p>We cannot tell the history of thoracic outlet syndrome without exploring the evolution of the name, \u2018thoracic outlet syndrome\u2019 itself. In fact, the terminology throughout the history of thoracic outlet syndrome evolved as the understanding of the disease evolved, and reflects the evolving school of thought at each time in history. Many of these historical syndromes are now known to represent different forms of thoracic outlet syndrome we see in different patients.<\/p><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8dfa45f elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"8dfa45f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ebb128e elementor-widget elementor-widget-heading\" data-id=\"ebb128e\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_Cervical_rib_syndrome\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Cervical rib syndrome\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-870cf75 elementor-widget elementor-widget-text-editor\" data-id=\"870cf75\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-9\"><p>Cervical rib syndrome\u2019 was the most well-known and widely used name for the syndrome throughout the late 19th century and into the early 20th century. Throughout the history of thoracic outlet syndrome, \u2018cervical rib syndrome\u2019 is likely more well-known than any other name. \u2018Cervical rib syndrome\u2019 is still used by some physicians today, and many physicians think primarily of a cervical rib when considering thoracic outlet syndrome.<\/p><p>The invention of radiographs in 1895 enabled the demonstration of cervical ribs in living patients, and established the relationship of cervical ribs and symptoms of brachial plexus entrapment. This relationship was widely recognized in the medical literature of the time, but the first actual use of the term \u201cCervical Rib Syndrome\u201d is by T. Wingate Todd in 1922.<\/p><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2cf3c5f elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"2cf3c5f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1c994a0 elementor-widget elementor-widget-heading\" data-id=\"1c994a0\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"oc_Brachial_Compression_Neuritis\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Brachial Compression Neuritis\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b89e41b elementor-widget elementor-widget-text-editor\" data-id=\"b89e41b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-9\"><p>This term was first used by Stopford in 1919. However the general term \u2018neuritis\u2019 had been used over the prior two decades to describe symptoms in these patients that were thought to be caused by compression of the brachial plexus.<\/p><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f5d4884 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"f5d4884\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-90efa58 elementor-widget elementor-widget-heading\" data-id=\"90efa58\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_Scalenus_anticus_syndrome\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Scalenus anticus syndrome<br>\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9d5b535 elementor-widget elementor-widget-heading\" data-id=\"9d5b535\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_Naffziger_syndrome\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Naffziger syndrome<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b9b2069 elementor-widget elementor-widget-text-editor\" data-id=\"b9b2069\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-10\"><p>\u2019Scalenus anticus\u2019 is another name for the anterior scalene muscle. Adson and Coffey wrote a landmark paper in 1927 describing their approach of detaching the scalenus anticus from its insertion on the first rib in patients with a cervical rib. Ochsner, Gage and DeBakey in 1935 were the first to describe patients with cervical rib syndrome without a cervical rib who had been treated successfully with the same procedure. They first used the term \u201cScalenus Anticus Syndrome,\u201d but credited their work to Howard Naffziger, and suggested the term \u201cNaffziger Syndrome\u201d as well.<\/p><\/div><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-cdb6760 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"cdb6760\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ea6ea6c elementor-widget elementor-widget-heading\" data-id=\"ea6ea6c\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_Costoclavicular_syndrome\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Costoclavicular syndrome<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-55984ed elementor-widget elementor-widget-heading\" data-id=\"55984ed\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_Costoclavicular_compression_syndrome\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">\nCostoclavicular compression syndrome<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-99b63ca elementor-widget elementor-widget-text-editor\" data-id=\"99b63ca\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-10\"><p>The mechanism of compression between the clavicle and first rib was first described by Eden in 1939 to explain vascular compression. Falconer and Weddell in 1943 described further cases with vascular compression, along with one case of brachial plexus compression. The term \u201ccostoclavicular syndrome\u201d was first used by Telford and Mottershead in 1947.<\/p><\/div><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-73a4181 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"73a4181\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c309233 elementor-widget elementor-widget-heading\" data-id=\"c309233\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_Hyperabduction_syndrome\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Hyperabduction syndrome\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f2657bb elementor-widget elementor-widget-text-editor\" data-id=\"f2657bb\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-10\"><p>Todd conducted an experiment upon himself by sleeping with his arm hyperabducted from 1913 to 1921. In the last 3 months of his experiment, he developed skin changes in his hand, but he did not propose a specific mechanism for these changes. In 1945, Irving Wright first described arterial and neurologic symptoms occurring with the arms hyperabducted. Wright proposed \u201cstretching, torsion and pinching\u201d in the costoclavicular interval and in the retropectoralis space. The term \u2018hyperabduction syndrome\u2019 was first used by Beyer and Wright in 1951.<\/p><\/div><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3693fad elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"3693fad\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-705e649 elementor-widget elementor-widget-heading\" data-id=\"705e649\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_Subcoracoid_pectoralis_minor_tendon_syndrome\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Subcoracoid pectoralis minor tendon syndrome<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d8a8b10 elementor-widget elementor-widget-heading\" data-id=\"d8a8b10\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_Wright_syndrome\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">\nWright syndrome<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-18715a0 elementor-widget elementor-widget-text-editor\" data-id=\"18715a0\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-10\"><div class=\"fusion-text fusion-text-13\"><p>These are other terms for hyperabduction syndrome.<\/p><\/div><\/div><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-af6bc23 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"af6bc23\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-265c2d1 elementor-widget elementor-widget-heading\" data-id=\"265c2d1\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_Brachiocephalic_syndrome\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Brachiocephalic syndrome<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-42b2a63 elementor-widget elementor-widget-heading\" data-id=\"42b2a63\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_Brachiocephalic_vascular_syndrome\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">\nBrachiocephalic vascular syndrome\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4b8ae95 elementor-widget elementor-widget-text-editor\" data-id=\"4b8ae95\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-10\"><div class=\"fusion-text fusion-text-13\"><div class=\"fusion-text fusion-text-14\"><p>In 1966, J.D. Devilliers first used the term \u2018brachiocephalic vascular syndrome\u2019 to describe a young woman with a stroke related to arterial TOS and a cervical rib.<\/p><\/div><\/div><\/div><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f3807c5 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"f3807c5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e87891d elementor-widget elementor-widget-heading\" data-id=\"e87891d\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_Nocturnal_paresthetic_brachialgia\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Nocturnal paresthetic brachialgia<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-44c262e elementor-widget elementor-widget-heading\" data-id=\"44c262e\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_Brachialgia_statica_paresthetica\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">\nBrachialgia statica paresthetica<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-11d414a elementor-widget elementor-widget-text-editor\" data-id=\"11d414a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-10\"><div class=\"fusion-text fusion-text-13\"><div class=\"fusion-text fusion-text-14\"><div class=\"fusion-text fusion-text-15\"><p>Introduced by Richard Wartenberg in 1944.<\/p><\/div><\/div><\/div><\/div><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-07ffa8c elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"07ffa8c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7867ddb elementor-widget elementor-widget-heading\" data-id=\"7867ddb\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_Effort_thrombosis_of_the_subclavian_vein\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Effort thrombosis of the subclavian vein<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7537f94 elementor-widget elementor-widget-heading\" data-id=\"7537f94\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_PagetSchroetter_syndrome\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Paget-Schroetter syndrome<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-38db1f6 elementor-widget elementor-widget-heading\" data-id=\"38db1f6\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_Axillarysubclavian_vein_thrombosis_ASVT\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">\nAxillary-subclavian vein thrombosis (ASVT)<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e61cfe9 elementor-widget elementor-widget-text-editor\" data-id=\"e61cfe9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-10\"><div class=\"fusion-text fusion-text-13\"><div class=\"fusion-text fusion-text-14\"><div class=\"fusion-text fusion-text-15\"><p>In 1875, Sir James Paget described two patients with spontaneous swelling of one arm and prominence of veins over the ipsilateral chest, likely the first described cases of venous TOS. Paget thought the condition was caused by vasospasm. In 1884, Leopold von Schr\u00f6tter independently described patients with the same condition, and correctly attributed the clinical condition to the formation of occlusive venous thrombus. In 1948, Hughes performed a review of a large number of cases in the medical literature, and proposed the term, \u201cPaget-Schr\u00f6tter Syndrome,\u201d which is still in use today.<\/p><p>Since von Schr\u00f6tter, clinicians had suspected that an episode of considerable exertion of the upper extremity could precipitate the thrombosis. Von Schr\u00f6tter had suggested it as a possible etiologic factor. Willan in 1918 described three cases, two of which he felt were due to \u201cvigorous exercise\u201d. The first actual use of the term \u2018effort thrombosis\u2019 I can find in the literature is by Swartley in 1942.<\/p><\/div><\/div><\/div><\/div><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b6128f2 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"b6128f2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5573fc5 elementor-widget elementor-widget-heading\" data-id=\"5573fc5\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_Cervicobrachial_Syndrome\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Cervicobrachial Syndrome\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7c3715a elementor-widget elementor-widget-text-editor\" data-id=\"7c3715a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-10\"><div class=\"fusion-text fusion-text-13\"><div class=\"fusion-text fusion-text-14\"><div class=\"fusion-text fusion-text-15\"><div class=\"fusion-text fusion-text-17\"><p>Kenneth Aynesworth first used this term in a paper published in 1940, in which he categorized three types of TOS. It was used again by Hansson in 1941, but since then the name has not come into common use.<\/p><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-338387e elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"338387e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5de9635 elementor-widget elementor-widget-heading\" data-id=\"5de9635\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_First_thoracic_rib_syndrome\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">First thoracic rib syndrome<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d0e757d elementor-widget elementor-widget-heading\" data-id=\"d0e757d\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_Superior_outlet_syndrome\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Superior outlet syndrome<br>\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-60cf193 elementor-widget elementor-widget-heading\" data-id=\"60cf193\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_Fractured_claviclerib_syndrome\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Fractured clavicle-rib syndrome<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7decdd9 elementor-widget elementor-widget-heading\" data-id=\"7decdd9\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_Cervical_rib_and_band_syndrome\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">\nCervical rib and band syndrome<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-310c35a elementor-widget elementor-widget-text-editor\" data-id=\"310c35a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-10\"><div class=\"fusion-text fusion-text-13\"><div class=\"fusion-text fusion-text-14\"><div class=\"fusion-text fusion-text-15\"><div class=\"fusion-text fusion-text-17\"><div class=\"fusion-text fusion-text-18\"><p>Mechanistic names which have never come into common use, and are of uncertain origin.<\/p><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-263cf17 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"263cf17\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0d9a8c1 elementor-widget elementor-widget-heading\" data-id=\"0d9a8c1\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_Thoracic_inlet_syndrome\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Thoracic inlet syndrome\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fe01b2c elementor-widget elementor-widget-text-editor\" data-id=\"fe01b2c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-10\"><div class=\"fusion-text fusion-text-13\"><div class=\"fusion-text fusion-text-14\"><div class=\"fusion-text fusion-text-15\"><div class=\"fusion-text fusion-text-17\"><div class=\"fusion-text fusion-text-18\"><div class=\"fusion-text fusion-text-19\"><p>Anatomists often refer to the space defined by the first ribs at the superior aspect of the thorax as the \u2018thoracic inlet,\u2019 because large veins, the trachea, the esophagus and other structures pass into this space (even as other structures pass out of the same space). However, physicians and other authorities almost always refer to this same space as the \u2018thoracic outlet\u2019. The terminology \u2018thoracic inlet syndrome\u2019 still enjoys limited use by anatomists, but is currently almost never used in clinical practice.<\/p><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d7d87ca elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"d7d87ca\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-38b5803 elementor-widget elementor-widget-heading\" data-id=\"38b5803\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_Pectoralis_minor_syndrome\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Pectoralis minor syndrome\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-997df85 elementor-widget elementor-widget-text-editor\" data-id=\"997df85\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-10\"><div class=\"fusion-text fusion-text-13\"><div class=\"fusion-text fusion-text-14\"><div class=\"fusion-text fusion-text-15\"><div class=\"fusion-text fusion-text-17\"><div class=\"fusion-text fusion-text-18\"><div class=\"fusion-text fusion-text-19\"><div class=\"fusion-text fusion-text-20\"><p>In 1956, Jere Lord and Peter Stone performed the first documented pectoralis minor tenotomy in 5 patients with hyperabduction syndrome. Although Lord and Stone apparently understood the importance of the retropectoralis space, the earliest mention of the name, \u201cpectoralis minor syndrome\u201d occurs in a paper published by Erich Lang in 1966.<\/p><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-38892ab elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"38892ab\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f9142b7 elementor-widget elementor-widget-heading\" data-id=\"f9142b7\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_Cervicodorsal_syndrome\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Cervicodorsal syndrome\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c57aa0f elementor-widget elementor-widget-text-editor\" data-id=\"c57aa0f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-10\"><div class=\"fusion-text fusion-text-13\"><div class=\"fusion-text fusion-text-14\"><div class=\"fusion-text fusion-text-15\"><div class=\"fusion-text fusion-text-17\"><div class=\"fusion-text fusion-text-18\"><div class=\"fusion-text fusion-text-19\"><div class=\"fusion-text fusion-text-20\"><div class=\"fusion-text fusion-text-21\"><p>First described in the literature by Paul Nelson in 1957 in an attempt to simplify and group the various neurovascular syndromes of the thoracic outlet, this term has not come into common use.<\/p><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-82a2d2f elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"82a2d2f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-459885b elementor-widget elementor-widget-heading\" data-id=\"459885b\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_Cervicoaxillary_syndrome\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Cervicoaxillary syndrome\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c26195d elementor-widget elementor-widget-text-editor\" data-id=\"c26195d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-10\"><div class=\"fusion-text fusion-text-13\"><div class=\"fusion-text fusion-text-14\"><div class=\"fusion-text fusion-text-15\"><div class=\"fusion-text fusion-text-17\"><div class=\"fusion-text fusion-text-18\"><div class=\"fusion-text fusion-text-19\"><div class=\"fusion-text fusion-text-20\"><div class=\"fusion-text fusion-text-21\"><div class=\"fusion-text fusion-text-22\"><p>Proposed by Don Ranney in 1996, to include subclassifications \u2018cervical outlet syndrome,\u2019 \u2018thoracic outlet syndrome,\u2019 \u2018costoclavicular syndrome,\u2019 and \u2018pectoralis minor syndrome,\u2019 and to eliminate \u2018thoracic inlet syndrome\u2019.<\/p><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-75f1ef7 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"75f1ef7\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9d1e69d elementor-widget elementor-widget-heading\" data-id=\"9d1e69d\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_Thoracic_Outlet_Syndrome\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Thoracic Outlet Syndrome<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e3804fa elementor-widget elementor-widget-heading\" data-id=\"e3804fa\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"oc_Thoracic_Outlet_Compression_Syndrome\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">\nThoracic Outlet Compression Syndrome<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8e24085 elementor-widget elementor-widget-text-editor\" data-id=\"8e24085\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-10\"><div class=\"fusion-text fusion-text-13\"><div class=\"fusion-text fusion-text-14\"><div class=\"fusion-text fusion-text-15\"><div class=\"fusion-text fusion-text-17\"><div class=\"fusion-text fusion-text-18\"><div class=\"fusion-text fusion-text-19\"><div class=\"fusion-text fusion-text-20\"><div class=\"fusion-text fusion-text-21\"><div class=\"fusion-text fusion-text-22\"><p>In 1956, Peet published a paper with the first instance of \u2018Throracic-outlet syndrome\u201d. This was the first documented attempt to unify the multitude of names and syndromes in the current medical literature. In 1958, C.G. Rob and A. Standeven published a paper entitled, \u201cArterial Occlusion Complicating Thoracic Outlet Compression Syndrome\u201d.<\/p><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-56a89c9 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"56a89c9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ed86a04 elementor-widget elementor-widget-heading\" data-id=\"ed86a04\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"toc_History_of_Thoracic_Outlet_Syndrome_Conclusion\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">History of Thoracic Outlet Syndrome: Conclusion\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1e70853 elementor-widget elementor-widget-text-editor\" data-id=\"1e70853\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-9\"><div class=\"fusion-text fusion-text-10\"><div class=\"fusion-text fusion-text-13\"><div class=\"fusion-text fusion-text-14\"><div class=\"fusion-text fusion-text-15\"><div class=\"fusion-text fusion-text-17\"><div class=\"fusion-text fusion-text-18\"><div class=\"fusion-text fusion-text-19\"><div class=\"fusion-text fusion-text-20\"><div class=\"fusion-text fusion-text-21\"><div class=\"fusion-text fusion-text-22\"><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-11 nonhundred-percent-fullwidth non-hundred-percent-height-scrolling fusion-equal-height-columns nitro-offscreen\"><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-12 fusion_builder_column_1_1 1_1 fusion-one-full fusion-column-first fusion-column-last\"><div class=\"fusion-column-wrapper fusion-flex-column-wrapper-legacy\"><div class=\"fusion-text fusion-text-24\"><p>This surprising array of names and syndromes may appear confusing and overwhelming. In fact, most physicians haven\u2019t heard of these syndromes. For these reasons, the creation of the term, \u2018thoracic outlet syndrome\u2019 may have been an unfortunate oversimplification. The unification of multiple syndromes under a single umbrella term blurs the differences between closely related but different underlying pathologies. On the other hand, when we are able to\u00a0accurately understand the anatomy in each individual, we are more able to make an effective diagnosis and treatment. That is our purpose and mission.<\/p><\/div><div class=\"fusion-clearfix\">\u00a0<\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-12 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling nitro-offscreen\"><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-stretch fusion-flex-justify-content-space-evenly fusion-flex-content-wrap\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-13 fusion_builder_column_1_3 1_3 fusion-flex-column\" data-scroll-devices=\"small-visibility,medium-visibility,large-visibility\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-center fusion-content-layout-row fusion-flex-align-items-center\">\u00a0<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-87c1a64 e-con-full e-flex e-con e-parent\" data-id=\"87c1a64\" data-element_type=\"container\" data-e-type=\"container\" id=\"toc_NeoVista_MRI_for_Thoracic_Outlet_Syndrome__1\">\n\t\t<div class=\"elementor-element elementor-element-a5f967b e-con-full e-flex e-con e-child\" data-id=\"a5f967b\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-0ab03c2 elementor-view-framed elementor-shape-circle elementor-position-block-start elementor-mobile-position-block-start elementor-widget elementor-widget-icon-box\" data-id=\"0ab03c2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-box.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-box-wrapper\">\n\n\t\t\t\t\t\t<div class=\"elementor-icon-box-icon\">\n\t\t\t\t<span  class=\"elementor-icon\">\n\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-info\" viewBox=\"0 0 192 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M20 424.229h20V279.771H20c-11.046 0-20-8.954-20-20V212c0-11.046 8.954-20 20-20h112c11.046 0 20 8.954 20 20v212.229h20c11.046 0 20 8.954 20 20V492c0 11.046-8.954 20-20 20H20c-11.046 0-20-8.954-20-20v-47.771c0-11.046 8.954-20 20-20zM96 0C56.235 0 24 32.235 24 72s32.235 72 72 72 72-32.235 72-72S135.764 0 96 0z\"><\/path><\/svg>\t\t\t\t<\/span>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t\t\t\t<div class=\"elementor-icon-box-content\">\n\n\t\t\t\t\t\t\t\t\t<h3 class=\"elementor-icon-box-title\">\n\t\t\t\t\t\t<span  >\n\t\t\t\t\t\t\tDiagnosis of Thoracic Outlet Syndrome\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<p class=\"elementor-icon-box-description\">\n\t\t\t\t\t\tDo you have pain, numbness, tingling or weakness? Click to learn more about the diagnosis of thoracic outlet syndrome.\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-cf8f5db e-con-full e-flex e-con e-child\" data-id=\"cf8f5db\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-60fc834 elementor-view-framed elementor-shape-circle elementor-position-block-start elementor-mobile-position-block-start elementor-widget elementor-widget-icon-box\" data-id=\"60fc834\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-box.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-box-wrapper\">\n\n\t\t\t\t\t\t<div class=\"elementor-icon-box-icon\">\n\t\t\t\t<span  class=\"elementor-icon\">\n\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-stethoscope\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M447.1 112c-34.2.5-62.3 28.4-63 62.6-.5 24.3 12.5 45.6 32 56.8V344c0 57.3-50.2 104-112 104-60 0-109.2-44.1-111.9-99.2C265 333.8 320 269.2 320 192V36.6c0-11.4-8.1-21.3-19.3-23.5L237.8.5c-13-2.6-25.6 5.8-28.2 18.8L206.4 35c-2.6 13 5.8 25.6 18.8 28.2l30.7 6.1v121.4c0 52.9-42.2 96.7-95.1 97.2-53.4.5-96.9-42.7-96.9-96V69.4l30.7-6.1c13-2.6 21.4-15.2 18.8-28.2l-3.1-15.7C107.7 6.4 95.1-2 82.1.6L19.3 13C8.1 15.3 0 25.1 0 36.6V192c0 77.3 55.1 142 128.1 156.8C130.7 439.2 208.6 512 304 512c97 0 176-75.4 176-168V231.4c19.1-11.1 32-31.7 32-55.4 0-35.7-29.2-64.5-64.9-64zm.9 80c-8.8 0-16-7.2-16-16s7.2-16 16-16 16 7.2 16 16-7.2 16-16 16z\"><\/path><\/svg>\t\t\t\t<\/span>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t\t\t\t<div class=\"elementor-icon-box-content\">\n\n\t\t\t\t\t\t\t\t\t<h3 class=\"elementor-icon-box-title\">\n\t\t\t\t\t\t<span  >\n\t\t\t\t\t\t\tNeoVista\u00ae MRI for Thoracic Outlet Syndrome\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<p class=\"elementor-icon-box-description\">\n\t\t\t\t\t\tLearn how the NeoVista\u00ae MRI for TOS provides diagnostic information that is not available elsewhere.\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-355293b e-con-full e-flex e-con e-child\" data-id=\"355293b\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-139b3a8 elementor-view-framed elementor-shape-circle elementor-position-block-start elementor-mobile-position-block-start elementor-widget elementor-widget-icon-box\" data-id=\"139b3a8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-box.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-box-wrapper\">\n\n\t\t\t\t\t\t<div class=\"elementor-icon-box-icon\">\n\t\t\t\t<span  class=\"elementor-icon\">\n\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-flask\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M437.2 403.5L320 215V64h8c13.3 0 24-10.7 24-24V24c0-13.3-10.7-24-24-24H120c-13.3 0-24 10.7-24 24v16c0 13.3 10.7 24 24 24h8v151L10.8 403.5C-18.5 450.6 15.3 512 70.9 512h306.2c55.7 0 89.4-61.5 60.1-108.5zM137.9 320l48.2-77.6c3.7-5.2 5.8-11.6 5.8-18.4V64h64v160c0 6.9 2.2 13.2 5.8 18.4l48.2 77.6h-172z\"><\/path><\/svg>\t\t\t\t<\/span>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t\t\t\t<div class=\"elementor-icon-box-content\">\n\n\t\t\t\t\t\t\t\t\t<h3 class=\"elementor-icon-box-title\">\n\t\t\t\t\t\t<span  >\n\t\t\t\t\t\t\tTreatment of Thoracic Outlet Syndrome\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<p class=\"elementor-icon-box-description\">\n\t\t\t\t\t\tBest treatment of thoracic outlet syndrome requires a dedicated team of thoracic outlet syndrome specialists.\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>History of Thoracic Outlet Syndrome Table of Contents The Cervical Rib Syndrome Cervical Rib Syndromes without a Cervical Rib Unification of Thoracic Outlet Syndromes and the Modern TOS Era Future Directions of TOS History of the name \u2018Thoracic Outlet Syndrome\u2019 Cervical rib syndrome Brachial Compression Neuritis Scalenus anticus syndrome Naffziger syndrome Costoclavicular syndrome Costoclavicular compression 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