Thoracic Outlet Syndrome Current Concepts of Treatment

This current concept of treatment of the Thoracic Outlet Syndrome based on a personal experience with 304 patients, resulted in complete (85%) or partial (7%) relief of symptoms in 92% of operated patients. The diagnosis centers upon a thorough history and the exclusion of other causes of arm and shoulder pain utilizing a strict flow pattern of differential diagnosis. Angiography and electromyography are of limited value and are only performed in selected cases. Operation should be reserved for the thoroughly evaluated patient who continues to have pain despite adequate conservative therapy. Transaxillary removal of the first rib, fibromuscular bands and cervical rib, when present, is the operation of choice. Summary The current concepts of treatment of 304 patients with TOS are reviewed. The diagnosis can be made with a high degree of accuracy by utilizing the combination of a detailed history, simple tests of physical examination and appropriate neurological and orthopedic consultations. If patients are highly selected through a thorough evaluation program surgery will result in gratifying relief of symptoms in over 90% of cases. The treatment of choice is meticulous resection of the first rib through a transaxillary approach.