Is Rib Resection Necessary for Relief of Thoracic Outlet Syndrome?

Abstract

Between 1966 and 1975, 425 patients with thoracic outlet symptoms were studied: 146 operative procedures were carried out in 103 of these patients. Division of soft tissues, only, in 129 cases offered relief of symptoms. In 10 cases bone resections (four cervical ribs, one second rib, one clavicle, and four first ribs) were done in an attempt to relieve the outlet problems. Preoperative evaluation included neurological consultation, x-rays of the neck and chest, detailed non-invasive oscillographic recordings of arterial flow during various outlet maneuvers, angiograms and in many instances electromyograms and nerve conduction studies. The axillary surgical approach to be various compression areas was preferred in that hyperabduction of the arm and costoclavicular maneuvers could be carried out under direct observation of the involved vessels. Accurate appraisal of the compression point could be assessed before and after the involved structure was divided or removed. Complications were limited to two hematomas postoperatively, and transient paralysis of the diaphragm in one patient. In all patients the vessel compression was relieved at the time of operation. In no instance was the first rib emperically removed as a "cure all" procedure. Six months following operation, patients were reevaluated and all except 8 patients (11 operative procedures) had relief of symptoms for a success rate of 92.5%.

Thoracic Outlet Syndrome With Negative Adson's and Hyperabduction Maneuvers

“…[24][25][26] Although nerve conduction studies have been reported to be valuable in diagnosing thoracic outlet syndrome, 13,27-29 the experience in this investigation revealed the inconsistency reported by others. 12,14,24,30,31 Depending frequently on the interest and expertise of the examiner, electromyography and nerve conduction testing have been quite helpful in some cases, but completely worthless in others. A number of patients with negative neuroelectrical tests achieved total relief following surgical decompression.…”

“…For many years thereafter, emphasis was placed on the consequences of vascular compression. [2][3][4][5][6][7][8][9][10][11][12][13] More recent reports have emphasized neural compression and/or irritation as the primary source of the thoracic outlet symptoms, irrespective of peripheral pulse change.14, 15 Indeed, a number of studies have shown that radial pulse obliteration with the arm and head in different positions is a normal finding in a large number of asymptomatic patients. Therefore occlusion of the radial pulse without symptom production when the arm is elevated or the shoulder braced and the head turned to either side would appear to indicate only that there is positional compression of the subclavian artery.…”

Neurogenic Thoracic Outlet and Pectoralis Minor Syndromes in Children

“…Between 1945 and 1984, there were very few reports of PMM involvement with what today is called PMS. 1,[10][11][12][13][14] After a gap of 20 years, recent reports appeared in 2004 and 2010. 7,15 This communication is the first to recognize that BPC in children often occurs in the PM space as well as in the scalene triangle.…”

Pectoralis Minor Syndrome

“…Although PMS was fi rst described in 1945 [ 4 ] , only four publications about this condition appeared over the next 59 years [5][6][7][8] . It was rediscovered in 1998 by Dr. George Thomas of Seattle; although he did not publish his observations, PMS was described in a 2004 paper on recurrent neurogenic TOS [ 9 ] .…”