Reappraisal of Surgical Treatment for Thoracic Outlet Syndrome by Technique Improvement

Abstract

Thoracic outlet syndrome (TOS) is a complex compressive neurovascular condition in the thoracic outlet, specifically at the scalene triangle. The nomenclature, diagnosis, and treatment remain controversial. From 1993 to 2003, 40 highly selected patients diagnosed with 44 TOSs were operated on at Chang Gung Memorial Hospital by the senior author. Four patients with bilateral TOSs underwent surgical intervention on both sides. Forty-one TOSs (41∕44, 93%) achieved excellent to good results. Three TOSs in three patients had no improvement due to additional causes. Complications due to operation were minimal. There were no cases with recurrent symptoms within one year of post-operative follow-up. Surgical intervention for intractable TOS was reappraised. An improved understanding of the scalenus anterior muscle anatomy and dynamic first rib abnormalities (size, shape, angulation, and tilting), clinical evaluation, and more accurate diagnosis ( first rib compression and reverse Adson tests, MRA imaging study) has revised patient selection.