1. Carroll, R.E. and Hurst, L.C. “The Relationship of Thoracic Outlet syndrome and Carpal tunnel syndrome.” CORR, 1982; 164:149-150.
The authors reviewed the limited literature on patients with carpal tunnel syndrome with those patients treated for thoracic outlet syndrome reflecting the frequent coexistence of carpal tunnel syndrome in the same patient in 44%. They concluded that thoracic outlet syndrome is a rare and difficult to diagnosis to make with certainty. They concluded that carpal tunnel syndrome continues to be incorrectly diagnosed as thoracic outlet syndrome and they stated, “It should not be forgotten that shoulder pain can be the presenting complaint in carpal tunnel syndrome.” They emphasize that thoracic outlet syndrome should not be diagnosed before excluding all other causes of upper extremity paresthesias.
2. Learmonth, J.R., “The principle of decompression in the treatment of certain diseases peripheral nerves.” Surgery of Obstetrics and Gynecology, 1933; 13:58:905-913.
This is one of the earliest articles discussing release of the pressure off entrapped peripheral nerves, i.e. those outside of the central nervous system. There are clinical examples of patients who required decompression of their peripheral nerve and the structures identified as causing the entrapment of the nerve. This is neither a landmark study, nor a definitive study, but more of an anecdotal report upon which research and further observation later added dramatically. Nevertheless, it was useful as an insightful account to draw attention to the fact that the peripheral nerve may precipitate symptoms related to entrapment and decompressing entrapment might relieve those symptoms.
They concluded that simultaneous occurrence of carpal tunnel syndrome and thoracic outlet syndrome is extremely rare, claiming that in 1,000 cases of coexistence carpal tunnel syndrome and 63 cases of thoracic outlet syndrome treated in their institution had not been noted. This is obviously in distinct contrast to the other authors whose papers they cited in their review. The suggestion is that thoracic outlet syndrome is usually an incorrect diagnosis and carpal tunnel syndrome is usually the sole cause of the patient’s symptoms or that in combination with cubital tunnel syndrome.
* Most of the TOS cases probably had CTS as well since TOS is very rare and hard to confirm.
Take Home Message: If the clinician is carefully examines the patient and makes the correct diagnosis, thoracic outlet syndrome will rarely be diagnosed because it is does not exist often. Therefore after treating the person’s carpal or cubital tunnel syndrome, there will no longer be any symptoms to incorrectly diagnoses as TOS.
3. Nathan, P.A., “Outcome Following Conservative Management of Thoracic Outlet Syndrome.” Letter to the Editor, JHS, 1996; 21A: 528.
4. Pfeffer, G.B., Gelberman, R.G., Boyes, J.H. and Rydevik, B., “The history of carpal tunnel syndrome.” JHS, 1988; 13B: 28-34.
This was a nice review of history of carpal tunnel syndrome. It helps to point out how long the incorrect diagnosis of thoracic outlet syndrome was the basis for treatment of carpal tunnel syndrome. The review of the history of carpal tunnel syndrome reflects the difficulty in figuring out the pathophysiology of a medical problem and arriving at the proper diagnosis and treatment of the problem. This article gives a good foundation for anyone interested in understanding misconceptions that have interfered with proper diagnosis and treatment of CTS.
5. Willbourn, A.J., Ledermann, R.J., “Evidence for conduction delay in thoracic-outlet syndrome is challenged.” Letter to the Editor, New England J of Med, 1984; 310: 310: 16: 1052-1053.
6. Willbourn, A.J., “TOS is over diagnosed.” Archives Neurol, 1990; 47:328.
Argues with good data against the diagnosis of thoracic outlet syndrome.
7. Willbourn, A.J., Porter, J.M. “Thoracic Outlet Syndromes.” N. Winer, MA (Ed): Spine: State of the Art Reviews. Philadelphia, Hanley, Belfus, 1988; 597-626.