ARTERIOGRAPHIC DIAGNOSIS OF THE THORACIC OUTLET SYNDROMES.

Abstract

The differentiation of the Various thoracic outlet syndromes has long presented vexing problems. The time-honored clinical criteria of dampening of the pulse and numbness and tingling of the upper extremities have failed to pinpoint the exact site and cause of the obstructing lesion. The significance of muscle tonus as a causative factor in these conditions has been recognized only recently. An accurate preoperative diagnosis and exact localization of the offending lesion or lesions will eliminate the element of chance in surgical correction of the thoracic outlet syndromes. Hitherto, the diagnosis has relied on the preoperative clinical examination which, in essence, depended upon the observation of changes of pulse characteristics in certain positions (15, 17, 18). The examination on the operating room table is handicapped by limitations of motion of the upper extremity under sterile field conditions. Hence, most lesions demonstrable only in exaggerated hyperabduction or flexion position cannot be appre...