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Invited Critique
Dec 2011

Thoracic Outlet Syndrome in Adolescents Is Real: Comment on “Spectrum of Thoracic Outlet Syndrome Presentation in Adolescents”

Author Affiliations

Author Affiliation: Division of Vascular Surgery, Department of Surgery, University of South Florida College of Medicine, Tampa.

Arch Surg. 2011;146(12):1388. doi:10.1001/archsurg.2011.1026

Chang and colleagues1 from The Johns Hopkins Medical Institutions have provided us with a very helpful review of TOS occurring in adolescent patients. While a limited number of similar studies have previously been published, this is by far the largest series and large enough, I think, to provide meaningful data.

Thoracic outlet syndrome is a “fuzzy” diagnosis; it is a real entity but one that is difficult to diagnose and that overlaps with multiple other problems. In adults, results are sometimes poor and the waters muddy. To a large extent, this is because adults often have numerous other factors in play, including liability and secondary gain issues, substance dependency and/or abuse, chronic regional pain syndrome, and underlying psychological disorders. The beauty of treating adolescents is that these factors are almost never in play; apart from the occasional case of Munchausen syndrome by proxy, adolescents with complaints of TOS have clear, unequivocal problems.

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