Operative treatment of thoracic outlet syndrome in Finland

The data from the nationwide hospital discharge register was used for collecting the diagnoses of the thoracic outlet syndrome (TOS) which were combined with the procedure numbers of first rib resection and scalenotomy. During the years 1987-1993 the total number of operative operative periods for patients with a TOS diagnosis was 483 for 464 patients. Each year first rib resections were done significantly (P = 0.001) more often (55.7 SE 7.1; 1.11/100,000) than scalenotomies (13.4 SE 1.8; 0.27/100,000). The operation for TOS was most commonly combined with the diagnosis of TOS with brachial plexus lesion in 53%, TOS NUD (not classified) in 21%, TOS with subclavian artery compression in 19%, with a cervical rib in 4% and TOS with venous compression in 3%. The large proportion of the diagnosis TOS NUD clearly shows the need for a better definition for the TOS diagnosis. As long as clear diagnostic criteria are lacking, the division of TOS into subgroups is arbitrary. Diagnostic division into true neurogenic, major arterial and venous TOS, and classifying the rest of the TOS diagnoses under TOS NUD or cervicobrachiale diffusum is recommended.