Management of thoracic outlet syndrome

The experience with transaxillary first-rib resection and scalenotomy reported herein shows these to be safe and effective treatments for patients with thoracic outlet syndrome (TOS). The former operation usually offers the best possibility for complete resection of the first rib and all anomalous congenital bands, and is curative in most cases, regardless of the mechanism of the compression. Scalenotomy, or Powers' operation, is also helpful, in particular for cases of TOS with a vertebral arterial insufficiency. Accurate diagnosis of TOS and selection for surgery after a detailed history and proper physical examination will result in gratifying relief of symptoms in almost all patients with TOS.