First rib resection for the thoracic outlet syndrome

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Vascular Surgery

Background:

• Thoracic outlet syndrome (TOS) can cause significant upper extremity pain and neurological deficits.
• Brachial plexus compression is a primary TOS cause, often diagnosed through specific clinical criteria.
• First rib resection is a surgical option for managing TOS.

Purpose of the Study:

• To evaluate the efficacy and outcomes of first rib resection in patients with TOS specifically due to brachial plexus compression.
• To assess the improvement rate and associated morbidity in a dedicated series of TOS patients.

Main Methods:

• A retrospective review of 25 patients undergoing first rib resection for TOS.
• Patients were selected based on specific diagnostic criteria for brachial plexus compression, including symptom reproduction and physical examination findings.
• Exclusion criteria included abnormal radiculograms.

Main Results:

• The study found a 60% chance of improvement in patients who underwent first rib resection.
• The surgical morbidity associated with the procedure was deemed acceptable.
• This series exclusively included patients operated on for brachial plexus compression.

Conclusions:

• First rib resection is an effective surgical intervention for thoracic outlet syndrome caused by brachial plexus compression.
• The procedure offers a favorable outcome with manageable complications for carefully selected patients.
• This study highlights the importance of precise diagnostic criteria for patient selection.