[Thoracic outlet syndrome: what is the current status?]. / Thoracic Outlet Syndrom: wo stehen wir heute?

Under certain circumstances patients with a constitutional predisposition, mainly with atypical ligaments and bands or a cervical rib may develop a Thoracic Outlet Syndrome (TOS). TOS can be divided into three subgroups: arterial, venous and neurogenic. Most of our cases have neurogenic symptoms combined with signs of arterial compression. The complications of TOS are arterial and venous. "TOS" is a clinical diagnosis. A history of upper extremity paresthesia that is exacerbated by abduction is typical for TOS. Objective neurological findings are usually lacking. Positive provocative maneuvers are suggestive, but not necessarily conclusive of TOS. Operations for TOS should be considered only when the diagnosis is certain, when conservative treatment has failed and when operative decompression is the only solution. Three quarter of the patients referred to us have a very mild TOS or are eventually diagnosed with other conditions and are not operated upon. Transaxillary first rib resection is recommended. The results are excellent, provided the diagnosis is accurate, the indication strict and the operative technique meticulous. Severe complications are infrequent.

[Popliteal artery entrapment syndrome: familial occurrence]. / Popliteal artery entrapment syndrome: familiäre Häufung.

So far only few cases of familial occurrence of popliteal artery entrapment have been reported. Such a case involving two brothers and one sister is described. Both the male subjects presented with additional patellar dysplasia and had to undergo surgical therapy. In the case of their sister a conservative treatment was sufficient.

[Neurovascular compression syndroms of the shoulder girdle (author's transl)]. / Neurovaskuläre Kompressionssyndrome im Schultergürtelbereich.

Shoulder girdle compression syndroms appear intermittently and according to body carriage. Very seldom they are caused by neck ribs, mostly by a costoclavicular narrowness. Important for the symptoms is the nerval plexus compression, for diagnostic reasons the blood vessel compression. Essential are provocating tests, subclavia phonogramms and in doubtful cases, angiography. Oszillo- and sonography often fail, EMG and nerval conductive measurement are only of differential diagnostik importance. In all together 120 healthy persons compression was shown phonographically, phlebographically and manometrically in 58--88%. Only the symptomatic and distinct compression are abnormal. Physiotherapy should be applied, only operative decompression is a causal treatment. The transaxilar resection of the first rib with scalenotomy and eventually also resection of a neck rib is by fat better than any other method. This is a report of 112 operated patients.

[Phleborgaphic studies of subclavian vein compression at the shoulder girdle]. / Phleborgraphische Untersuchungen über Kompressionserscheinungen beim Schultergürtelsyndrom

60 healthy persons without clinical signs of neurovascular compression at the shoulder girdle were investigated with phlebograms of the arm under various arm-positions. Venous obstruction could be demonstrated under hyperabduction and shoulder-retraction in 70 per cent of the phlebograms. A compression of the subclavian vein in extreme positions of the arm can therefore be demonstrated in a significant number of healthy individuals. A narrowing of the costoclavicular space and an impression by the head of the humerus seem tobe the most frequent mechanisms of compression. Repeated compression between clavicula and first rib leads to thickening of the vein wall, forced expiration (Valsalva) to temporary stasis. These mechanisms could be the reason for primary subclavian vein thrombosis in otherwise healthy individuals.