The results of first rib resection in thoracic outlet syndrome

Twenty cases of thoracic outlet syndrome in seventeen patients were treated by first rib resections through the transaxillary approach, after conservative therapy failed. The average follow up was twenty-four months. The mean age was thirtyfive years with a range of fifteen to fifty-four years. There were fourteen females and three males. The delay in diagnosis averaged four years with the most common mistaken diagnosis being cervical disc disease. Complications included two cases of pneumothorax, one wound infection, and one intraoperative hemorrhage. Fourteen of the patients had complete relief of pain while two of the patients were improved. There was only one patient who was considered a failure because of recurrent pain. It is concluded that this procedure should be considered when conservative measures fail. The orthopaedist is usually the first to see the patient, and therefore, the diagnosis should be considered in all patients with upper extremity pain.