[Thoracic outlet syndrome: what is the current status?]

Under certain circumstances patients with a constitutional predisposition, mainly with atypical ligaments and bands or a cervical rib may develop a Thoracic Outlet Syndrome (TOS). TOS can be divided into three subgroups: arterial, venous and neurogenic. Most of our cases have neurogenic symptoms combined with signs of arterial compression. The complications of TOS are arterial and venous. "TOS" is a clinical diagnosis. A history of upper extremity paresthesia that is exacerbated by abduction is typical for TOS. Objective neurological findings are usually lacking. Positive provocative maneuvers are suggestive, but not necessarily conclusive of TOS. Operations for TOS should be considered only when the diagnosis is certain, when conservative treatment has failed and when operative decompression is the only solution. Three quarter of the patients referred to us have a very mild TOS or are eventually diagnosed with other conditions and are not operated upon. Transaxillary first rib resection is recommended. The results are excellent, provided the diagnosis is accurate, the indication strict and the operative technique meticulous. Severe complications are infrequent.