[Thoracic outlet syndrome. Apropos of 112 cases: toward a more refined tactical approach]

A total of 112 operations were performed in 87 patients with a cervicobrachial syndrome, 25 with bilateral lesions, over a period of 8 years. Surgery was reserved for severe or complicated cases. Presenting signs were complex and intricated in 53 p. cent of cases, with neurological lesions predominating. Absence of radial pulse after 90 degrees abduction of the arm, present in 87 p. cent of patients, is not a specific diagnostic test as positive results are obtained in over one-third of a normal population. Electromyography confirmed clinical lesions of the brachial plexus in only one out of 8 cases. A more precise and more sensitive procedure for electromyographic exploration of the plexus was therefore established. Dynamic arteriography of the upper limbs was not conducted routinely (70 p. cent of cases), but was reserved for arterial, neuro-arterial, and arterial and venous forms. The axillary approach was used exclusively (94 times), between 1974 and 1980. However, the frequency of postoperative complications (10 p. cent), and the high level of poor or incomplete results (19.5 p. cent) led to the reestablishment of the supraclavicular route of approach. The latter is used preferentially in neurological forms (57 p. cent of cases in this series) in cases requiring correction of an arterial lesion (aneurysm, ulcerated plaque), or when a cervical rib or apophysomegalia of the 7th cervical vertebra is associated.