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March 1990

The Thoracic Outlet Syndrome

Arch Neurol. 1990;47(3):330. doi:10.1001/archneur.1990.00530030108025

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We tend to find what we look for. Roos encountered "significant soft-tissue anomalies in the thoracic outlet and scalene triangle not illustrated in anatomy textbooks in 33% of cadaver dissections." And yet, it is difficult to know how many of the subj ects had symptoms and signs in life. Similarly, even if anatomic variants are found at operation and symptomatic relief is achieved after it, a firm causal relationship cannot be established, particularly if dealing with pain, a modality highly responsive to dramatic intervention.

As Wilbourn points out, the term "thoracic outlet syndrome" is applied to a wide range of entities, from the indisputable to the incredible. Unless the syndrome is cleaved into objectively defined subcategories and subjected to unbiased therapeutic evaluations, the debate about its frequency will never cease.

Given Roos' pioneering work in this field, his reputation, and the nature of his practice, the thoracic outlet syndrome may

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