[Does the thoracic outlet syndrome exist?].

Abstract

We reviewed fourteen patients suffering from thoracic outlet syndrome (TOS). This allowed a critical analysis of the diagnostic tools, especially the Adson and Allen tests, currently used. The value of arthrography and phlebography are discussed in relation to the supposed pathophysiology of the disease. The decision to operate on those patients has to be considered in relation to the possible mishaps related to the surgical procedure. Particular attention has to be paid to post-operative perineural fibrosis, a possible cause of definite disability. The psychological components seem to remain mostly underestimated, a fact that has to be stressed and which we were able to demonstrate in our small sample. However, pre-operative evaluation remains difficult. No definite objective sign enables the surgeon to assert the presence of a thoracic outlet syndrome. Therefore not only the decision making but also the analysis of the results remains debatable. In all cases, even in the presence of clear narrowing of the vessels, indication to operation should be restrictive.