Thoracic outlet syndrome with special reference to the first rib

The thoracic outlet syndrome (TOS) is a highly controversial concept. The incidence of TOS is high in the United States, essentially unknown in Australia and seldom diagnosed in Great Britain. In spite of the skepticism in the recent medical literature many patients are still surgically treated with resection of the first rib for a symptom complex diagnosed as TOS. Resection of the first rib is the most extensively used surgical approach in the treatment of TOS. This operation gives a good result in 24% to 100% of the patients. The reasons for this huge variation are considered to be related to difficulties in patient selection, variable examination procedures, operative techniques and a lack of proper follow-up. The goal of this review is to bring forth the diverging results after first rib resection for TOS and to pinpoint the importance of further studies concerning the possible functional disturbance of the thoracic outlet in these patients. Conservatism is encouraged.