Is rib resection necessary for relief of thoracic outlet syndrome?

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%.