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March 1990

The Thoracic Outlet Syndrome Is Overdiagnosed

Author Affiliations

From the Electromyography Laboratory, Neurology Department, Cleveland (Ohio) Clinic Foundation.

Arch Neurol. 1990;47(3):328-330. doi:10.1001/archneur.1990.00530030106024

Thoracic outlet syndrome (TOS) refers to disorders attributed to compromise of the neurovascular structures—subclavian/axillary artery and vein, distal cervical roots, brachial plexus fibers—traversing the thoracic outlet.1 Thoracic outlet syndrome can be subdivided into four distinct subgroups, depending on the particular structure affected, because seldom is more than one involved simultaneously.2 These subgroups are arterial vascular, venous vascular, true (or classic) neurologic, and disputed neurologic.3 The first three types are noncontroversial. Because of space limitations the vascular types cannot be discussed in detail; detailed descriptions of them are available.3-6 They share several common features with the true neurologic type (true N-TOS), including characteristic symptom profile, obvious clinical findings, confirmatory results of laboratory studies, worldwide recognition as an entity, and low incidence. For example, true N-TOS is a rare lesion that occurs unilaterally and primarily affects adult women. Caused by the distal C-8/T-1 roots or proximal lower trunk

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