Pathophysiology and selection of method for surgical management of thoracic outlet syndrome

Over the period of 1977-82 seventy-eight patients with thoracic outlet syndrome were examined and treated at our Institute. Sixty-eight patients were operated on. The average age of the patients was 34.6. Women prevailed (42 patients). Trauma accounted for syndrome development in 36 patients. In the remaining patients congenital and acquired osseous alterations, supernumerary scalene muscle, congenital fibrous bands were the etiologic factors. Uncomplicated thoracic outlet syndrome was found in 36 patients, a complicated form--in 32 out of 68 patients operated on. The essential role of neurogenic factors in the development of the disease, especially of the uncomplicated variety was disclosed. In bony pathology one noted early appearance and prevalence of vascular complications. First rib resection should be considered the principal type of decompressive operation. Selection of approach and use of other surgical interventions is determined by clinical presentation of complications. Good and satisfactory results after surgical treatment were obtained in 61 patients (89.7%).