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Updated: May 27, 2026
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Transaxillary First Rib Resection for Treatment of the Thoracic Outlet Syndrome
Published on: September 13, 2020
Surgery for paediatric thoracic outlet syndrome.
P J Teddy1, R D Johnson, R R Cai
1Department of Surgery, Royal Melbourne Hospital, Grattan Street, Parkville, Melbourne, Victoria 3050, Australia. Peter.Teddy@rmh.org.au
Summary
Operative treatment for pediatric thoracic outlet syndrome (TOS) shows success, particularly in alleviating vascular symptoms. While pain relief was inconsistent, surgery improved function and overall outcomes for young patients with TOS.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Thoracic outlet syndrome (TOS) in pediatric patients presents unique challenges in definition, etiology, and diagnosis.
- Operative treatment effectiveness for pediatric TOS requires further analysis to optimize patient outcomes.
Purpose of the Study:
- To analyze the effectiveness of surgical interventions for pediatric thoracic outlet syndrome (TOS).
- To refine the understanding of TOS presentation, etiology, and diagnosis in patients under 18.
- To evaluate postoperative pain, functional recovery, and overall outcomes following surgical treatment.
Main Methods:
- Retrospective review of 13 pediatric patients (<18 years) undergoing surgical treatment for TOS by a single surgeon.
- Analysis of 20 operations, including 17 scalenotomies and 3 transaxillary rib resections (TARRs).
- Follow-up duration ranged from 6 to 96 months post-operatively.
Main Results:
- Surgery effectively alleviated TOS symptoms, notably vascular compromise.
- Pain resolution post-surgery was inconsistent, and improvement in motor deficits was poor.
- Mean functional improvement was good, with excellent overall operative outcomes reported.
- Anatomical anomalies and sports participation were identified as potential factors in early-onset pediatric TOS.
Conclusions:
- Surgical intervention is a successful treatment modality for pediatric TOS, particularly for vascular symptoms.
- While functional outcomes are generally positive, further strategies may be needed to address persistent pain and motor deficits.
- Understanding the role of anatomical variations and activity levels is crucial for managing pediatric TOS.
