Anatomical bases of transaxillary resection of the first rib

Complications of surgery for thoracic outlet syndrome

Having read through the previous litany of potential disasters and complications, one could ask the obvious question, "Why would anyone want to do this kind of surgery?" The answer is that most people elect not to! Nevertheless, for those who decide to venture into this field, there is the tremendous reward of being able to help patients who would otherwise continue to live with extremely disabling and disheartening symptoms. A sound knowledge of the regional anatomy and tutelage by those knowledgeable in particular areas of surgery that may not have been a part of the individual surgeon's prior training is essential. The author was fortunate to have the help of a very accomplished and generous vascular surgeon, Dr. William Abbott of the Massachusetts General Hospital for many months when I began on what I have considered a fascinating and intellectually rewarding odyssey.

Thoracic outlet syndrome

A careful history and thorough physical examination are the most important components in establishing the diagnosis of TOS. The use of radiographic and laboratory tests, when indicated, can improve the diagnostic yield. Provocative positional maneuvers must be evaluated for their vascular and, more important, for their neurologic response. These maneuvers do not "make" the diagnosis, but they can be a useful adjunct for confirming the diagnosis. Vascular TOS is less common and often requires surgical treatment. Neurologic TOS is very common but less frequently requires surgical treatment. The surgical approach and procedure selection should be determined by the nature of the pathologic condition and site of compression.

Lower trunk brachial plexus compression neuropathy due to cervical rib in young athletes

Compression by a cervical rib may result in neurologic and/or vascular symptoms. Two patients are reported with thoracic outlet syndrome (TOS) secondary to cervical rib. Both patients had vague shoulder pain as well as neurologic manifestations due to compression neuropathy of the lower trunk of the brachial plexus. One patient was suspected initially to have carpal tunnel syndrome.