Treatment of thoracic outlet syndrome by removal of first rib and related entrapments through posterolateral approach: A 22 year experience

Abstract

A total of 110 patients have been operated upon for thoracic outlet syndrome. Follow-up has been maintained in 106. A posterolateral approach was adequate for removal of the first rib and related entrapments. Sixty-one entrapments related to the first rib in 53 operations were observed. Results were very satisfactory in 92.5 per cent; 5.6 per cent were classified as improved and 1.9 per cent as unimproved. There were no operative complications and no injury to the brachial plexus, subclavian artery, or vein. A variable clinical profile was recognizable. Oscillotonometric recording during outlet maneuvers provided necessary objectivity for vascular compression during the thoracic outlet as did electromyography for brachial plexus compression. Cinegraphic study of the coronary arteries was helpful in a select group of cases. In terms of results and gratitude of patients, this series of operations was a rewarding experience.