Thoracic outlet syndrome surgery causing severe brachial plexopathy

Hundreds of first rib resections are performed yearly in the United States to treat a controversial type of neurogenic thoracic outlet syndrome (NTOS). This surgery was thought to be devoid of serious neurological complications until 1982. However, that year Dale unearthed the rather astounding fact that the members of a single surgical society were aware of nearly 300 brachial plexus injuries resulting in motor deficits that had occurred during such operations, although almost none had been reported in the literature. In this report the features of the two main types of NTOS ("true" and "disputed") are discussed. The history of brachial plexus injury occurring during TOS surgery is traced back to the late nineteenth century. The clinical and electrophysiological features of eight patients who sustained such injuries are described in detail, the literature on this topic is reviewed, and the location and causes for these injuries are discussed.