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Updated: May 9, 2026
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Transaxillary First Rib Resection for Treatment of the Thoracic Outlet Syndrome
Published on: September 13, 2020
A hand surgeon's advanced experience with thoracic outlet compression syndrome
1Kleinert Kutz Hand Care Center, Louisville, Kentucky 40202, USA. eatasoy@kleinertkutz.com
Handchirurgie, Mikrochirurgie, Plastische Chirurgie : Organ Der Deutschsprachigen Arbeitsgemeinschaft Fur Handchirurgie : Organ Der Deutschsprachigen Arbeitsgemeinschaft Fur Mikrochirurgie Der Peripheren Nerven Und Gefasse : Organ Der V
|July 18, 2013
Summary
Thoracic Outlet Compression Syndrome (TOCS) is often overlooked. A combined surgical approach, including first rib resection and scalenectomy, demonstrated a 95% symptom improvement rate in patients with TOCS.
Area of Science:
- Orthopedics
- Neurosurgery
- Vascular Surgery
Background:
- Thoracic Outlet Compression Syndrome (TOCS) is frequently misdiagnosed due to subjective symptoms in 90% of patients.
- Upper extremity pain, numbness, and tingling are common complaints, yet TOCS is often not considered by hand surgeons.
- The condition has historically been controversial due to a lack of objective findings in many cases.
Purpose of the Study:
- To evaluate the efficacy of a combined surgical approach for treating Thoracic Outlet Compression Syndrome (TOCS).
- To assess the long-term outcomes and recurrence rates of this surgical intervention.
Main Methods:
- A combined surgical approach involving transaxillary first rib resection with immediate transcervical anterior and middle scalenectomy was performed.
- Follow-up data was collected via questionnaires from patients who underwent the procedure between 1989 and 2012.
- Patient outcomes were analyzed based on reported symptom improvement.
Main Results:
- Over 850 procedures were performed over 22 years.
- In a cohort of 102 respondents from 1989-2002, 95% reported symptom improvement.
- In a subsequent cohort of 57 respondents (76 procedures) from 2003-2012, 95% also reported symptom improvement.
Conclusions:
- The combined surgical approach for TOCS is a highly effective intervention.
- This surgical technique offers a high rate of symptom improvement and a low rate of recurrence.
- Recognizing and diagnosing TOCS is crucial for effective patient management.
