Thoracic outlet syndrome

Thoracic outlet syndrome includes a variety of previously described syndromes, the common factor being compression of the neurovascular bundle as it exists from the thoracic outlet. Diagnosis is largely one of exclusion but may be aided in some patients by angiography, assessment of the conduction velocity of the ulnar nerve, and other objective tests. Many patients can improve with conservative treatment, but in those requiring surgery, the best results have been obtained with first rib resection. Currently, the most popular approach is transaxillary, and more than 90 per cent of patients with thoracic outlet syndrome will be relieved by this procedure.