About Us
During the past 5 decades, the recognition and management of thoracic
outlet syndrome (TOS) have evolved. This page elucidates these changes
and improvements in the diagnosis and management of TOS at Baylor
University Medical Center. The most remarkable change over the past
50 years is the use of nerve conduction velocity to diagnose and monitor
patients with nerve compression. Recognition that procedures such
as breast implantation and median sternotomy may produce TOS has
been revealing. Prompt thrombolysis followed by surgical venous decompression
for Paget-Schroetter syndrome has markedly improved results
compared with the conservative anticoagulation approach; thrombolysis
and prompt first rib resection is the optimal treatment for most patients
with Paget-Schroetter syndrome. Complete first rib extirpation at the initial
procedure markedly reduces the incidence of recurrent neurologic symptoms
or the need for a second procedure. Chest pain or pseudoangina
can be caused by TOS. Dorsal sympathectomy is helpful for patients with
sympathetic maintained pain syndrome or causalgia and patients with
recurrent TOS symptoms who need a second procedure.
Mission
Dr. Urschel, developed a personal interest
in the diagnosis and treatment of TOS while he played
college football at Princeton from 1947 to 1951. Recruited
from Ohio, where he was all-state, to play blocking back in
Charles Caldwell’s single-wing formation, he noticed that when
his neck was knocked to the right, his arm would be paralyzed
for 2 days. He was sent to Johns Hopkins Hospital to see Dr.
George Bennett, who had just operated on Joe DiMaggio’s knee.
After the examination, Dr. Bennett said, “Urschel, you have an
extra (cervical) rib for which I can either operate or build you a
brace.” Realizing early that “surgery was for others,” he elected
the brace. They forged a piece of steel to his shoulder pad and
covered it with leather. It was excellent and highly successful in
alleviating his symptoms. However, because players didn’t wear
face masks, occasionally the steel brace would take a nose off. It
was prohibited at the end of the year, and Urschel was given the first "doughnut" pad to wear around his neck, like many players
wear today. That Princeton football team was outstanding in
the “golden era” of Ivy League football: they were undefeated 3
out of 4 years; were ranked second in the nation and first in offense
and rushing; and never played with less than 70,000 people in the
stands. Caldwell was named college coach of the year, and Dick
Kazmaier, triple-threat tailback, won the Heisman trophy.
When Dr. Urschel attended Harvard Medical School and
was chief surgical resident at the Massachusetts General Hospital,
many teachers, particularly neurologists, dismissed the
diagnosis of TOS and said it didn’t exist. Dr. Urschel knew
better, and it has been one of his avocations ever since.