Transaxillary first rib resection for thoracic outlet syndrome: follow-up of 9 cases

Nine cases of Thoracic Outlet Syndrome (TOS) were treated by transaxillary 1st rib resection over a three year period. Mean follow-up was 26 +/- 4 months. Patients were recalled every 3 months post-operatively for surveillance. Parameters for evaluation included physical examination, return of patient to (full-range or partial range) pre-illness activity, nerve conduction velocities, somato-sensory evoked potentials, Duplex imaging and venography or arteriography if the latter two were indicated. Neurogenic involvement with or without vascular compression was present in 7 cases (78%) and satisfactory results of surgery were recorded in 6 patients (67%). The clinical settings and detailed results are reviewed and variable factors that might alter the outcome are analyzed in this series. Neither duration of symptoms, sex differences nor associated bony anomalies had any effect on operative results. The single factor that seemingly had a negative impact on the outcome after surgery was the patient's need to return to strenuous and repetitive arm and/or hand movements.