Critical reappraisal of diagnostic and therapeutic modalities for thoracic outlet syndromes.

A brief conceptual history of neurovascular compression in the thoracic outlet with emphasis on surgical intervention is presented. After the description of techniques for the removal of the first rib in 1962 and 1966, an explosion of operations for thoracic outlet syndromes occurred during the next two decades. A critical reappraisal by several experienced surgeons has led to a re-examination of the indications for surgical intervention. Serious complications involving the brachial plexus and the subclavian artery and vein have unfortunately led to widespread litigation. An attempt is made to define the place of diagnostic and therapeutic modalities that will encourage a favorable outcome in most patients.