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D B Roos

Publications and source records attributed to D B Roos.

17 recordsLinked to original sources
PubMed1996

Historical perspectives and anatomic considerations. Thoracic outlet syndrome.

The major developments in the evolution of understanding the thoracic outlet syndromes is presented in a chronologically historical record beginning with the first mention of a cervical rib by Galen in the second century A.D. Appreciation of the vascular and neurologic types of TOS progressed slowly through the centuries until detailed clinical studies were presented in the early 1900s. Interest in these syndromes increased steadily since then with description of the effectiveness of first rib resection by Murphy in 1910, and scalenotomy without cervical rib resection favored by Adson in 1927. The term "thoracic outlet syndrome" was coined by Peete et al in 1956 to encompass all the forms and causes of neurovascular compression in the base of the neck. Although rib resection may be considered the oldest operation on mankind, its application to treatment for TOS became popular only after Clagett's description of the posterior periscapular approach in 1962 and the transaxillary approach in 1966. The techniques of arteriography and venography were introduced in the 1960s and remain the hallmark for evaluation of the arterial and venous types of TOS. The neuroelectric studies introduced by Jebsen in 1968 have become popular, but offer little definitive diagnostic information for the neurogenic form of this syndrome. Recent histochemical studies of scalene muscles have shown important changes at the cellular level of the scalene muscles with trauma leading to TOS. The basic cause of the various neurovascular symptoms relates to anatomic abnormalities, either congenital or developmental, that cause abnormal compression and irritation of the major nerves and vessels in the thoracic outlet, causing certain people to have anatomic susceptibility to develop symptoms under certain conditions. These anomalies are described in some detail to facilitate the understanding, diagnosis, and surgical treatment of these special patients.

History, 19th Century↗
PubMed1995

Shoulder-arm pain from cervical bands and scalene muscle anomalies.

Fourteen patients were identified with (1) pain and sensory changes in a brachial plexus distribution, (2) aggravation of pain with use of the affected extremity, and (3) pain on palpation over the brachial plexus. All patients had minimal or no intrinsic hand muscle atrophy. Only one patient had cervical ribs. Nerve conduction studies were normal, and electromyography (EMG) showed mild chronic neuropathic changes in 2 patients. None of the patients responded to conservative therapy over a prolonged period (7-12 months). A compressive brachial plexopathy from abnormally attached or enlarged scalene muscles that affected both upper and lower trunks of the brachial plexus was found at surgery in all patients. In 13 patients, at least one fibrous band compressed the lower trunk of the brachial plexus. Therefore, neurogenic thoracic outlet syndrome can occur from cervical bands and scalene muscle anomalies without intrinsic hand muscle atrophy, cervical ribs, enlarged C7 transverse processes, or EMG abnormalities.

Adolescent↗
PubMed1982

The place for scalenectomy and first-rib resection in thoracic outlet syndrome.

For more than a century, physicians have been seeking the elusive answers to the accurate diagnosis and reliable treatment of the thoracic outlet syndromes (TOS). From evaluation of 3630 patients for possible TOS, two distinct patterns of neurologic symptoms seem apparent, that affecting the upper roots of the brachial plexus (C5, C6, and C7) and that affecting the lower roots (CS and T1). Some patients may have both types simultaneously or sequentially. The important aspects of the history and physical examination of both types of TOS are discussed. The technique of an operation, complete anterior scalenectomy, specifically designed to relieve the upper plexus type of TOS is presented, along with the congenital anomalies that invariably seem to be associated with this syndrome. In a series of 1336 first-rib resections performed for severe TOS over the past 17 years, 92% of the operations resulted in good to excellent relief for the patient. In a series of 93 scalenectomies performed over the past 6 years specifically for upper plexus type of TOS, either primary or secondary from recurrence, every patient has obtained substantial relief.

Adult↗
PubMed1976

Congenital anomalies associated with thoracic outlet syndrome. Anatomy, symptoms, diagnosis, and treatment.

Personal evaluation of more than 2,300 patients for possible thoracic outlet syndrome (TOS) and knowledge gained from 980 TOS operations in 766 patients (operative incidence of 33.7 per cent of the patients examined) have shown that most patients with TOS have anomalous fibrous muscular bands near the brachial plexus that predispose them to neurologic irritation or compression involving the plexus. Anatomic analysis during operations for TOS, plus cadaver dissections, have disclosed seven distinct types of fibromuscular bands in addition to the less frequent bony anomalies long associated with neurovascular compression. One third of fifty-eight cadaver thoracic outlets dissected showed at least one of the seven muscular anomalies recognized at operations. These anomalies can be accurately related to the patients' symptoms, which are neurologic complaints in 99 per cent of the patients examined who ultimately have the diagnosis of TOS established. Neurologic symptoms are clearly explained by the anomalous bands irritating or compressing the brachial plexus and rarely have any effect on the subclavian vessels. These studies, and others before, have shown no correlation with impairment of circulation or positional radial pulse changes in almost all patients with true TOS. Also, arteriograms and nerve conduction studies generally have failed to be of value in establishing the accurate diagnosis. Reasons for these conclusions are explained, and the most reliable tests are described. The most effective means of relief of severe symptoms of TOS is to alter the mechanical irritation or compression of the brachial plexus by completely resecting the first throacic rib and all anomalous fibromuscular tissue around the plexus and subclavian vessels. If patients are are throughly evaluated with appropriate tests and highly selected for surgical treatment, gratifying relief will result in more than 90 per cent of patients, if the correct operation is performed with meticulous technic.

Cervical Vertebrae↗
PubMedDate not supplied

Pathophysiology of congenital anomalies in thoracic outlet syndrome.

Careful anatomic studies during 1,120 operations for thoracic outlet syndrome indicate that most TOS patients have anomalous fibromuscular bands near the brachial plexus and subclavian vessels that predispose them to neurovascular symptoms in the shoulder and upper extremity. Nine different types of these "soft tissue" anomalies not visible on roentgenograms have been identified during these operations. The anomalies often are multiple, and may or may not be associated with bone abnormalities as well. These anomalies are clearly associated with the symptoms of thoracic outlet syndrome, particularly the neurologic type, as they apparently irritate or compress the brachial plexus. Thus, it finally becomes clear why the majority of symptoms of TOS are neurologic in nature, rather than vascular, and why the positional pulse tests and arteriograms, strongly advocated in the past for this diagnosis, have proved generally unreliable. Furthermore, the anomalous bands explain why the electromyogram and nerve conduction tests are of little benefit in establishing the accurate diagnosis of TOS. They even indicate the most reliable clinical tests to establish the diagnosis, and dictate the most appropriate surgical procedures required to offer permanent relief. If patients with shoulder, arm and hand symptoms are carefully evaluated with appropriate tests, and then highly selected for surgical treatment after conservative measures fail, gratifying relief may still be obtained in over 90% of patients with severe thoracic outlet syndrome, providing the diagnosis is correct, and the proper operation is performed with great care.

Cervical Rib Syndrome↗
PubMedDate not supplied

Recurrent thoracic outlet syndrome after first rib resection.

After initial relief of severe thoracic outlet syndrome by transaxillary resection of the first rib, a few patients may gradually develop recurrent neurologic symptoms in the neck, shoulder, arm and hand caused by postoperative scar tissue entrapment of segments of the brachial plexus. Once they begin, these symptoms may relentlessly progress to the extent they become unresponsive to all forms of conservative management. Two distinct patterns of recurrent TOS, which may occur separately or simultaneously, have been identified. Clinical measures that have proved effective in establishing the diagnosis of these types, the surgical techniques developed to offer relief, and measures to help prevent recurrence are discussed in this paper. A series of 76 patients who underwent operation for disabling recurrent TOS is presented. The principals of the etiology, diagnosis and surgical treatment described have offered significant, if not total, relief of the severe symptoms. The operations which have proved to be the most effective, however, are high-risk, technically demanding procedures which should be performed only by surgeons with wide experience in the anatomy and surgery of the thoracic outlet region. Although these techniques may offer patients significant relief, prevention of the recurrent thoracic outlet syndrome is still the best cure.

Cervical Rib Syndrome↗