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Transaxillary First Rib Resection for the Thoracic Outlet Syndrome

Transaxillary First Rib Resection for the Thoracic Outlet Syndrome Abstract THE THORACIC outlet syndrome is a group of neurovascular symptoms in the neck, shoulder, arm, or hand related to compression of the subclavian vessels and brachial plexus. This condition has been recognized under a variety of names, the most familiar of which is the scalenous anticus syndrome.1 In 1956, Peet et al suggested the term "thoracic outlet compression syndrome" to include all of the recognized syndromes which are related to pressure on the neurovascular structures supplying the upper extremity.2 Scalenotomy has been the most popular surgical therapy until recently. Because of the significant failure rate with scalenotomy, attention has currently shifted to removal of the first rib. Resection of this rib for relief of neurovascular compression dates back to 1910.3 Scattered reports of good results from first rib resection appeared in the literature during the ensuing 50 years but received little attention.4-6 In 1962, Clagett revived References 1. Ochsner, A.; Gage, M.; and DeBakey, M.: Scalenus Anticus (Naffziger) Syndrome , Amer J Surg 28:669-695, 1935.Crossref 2. Peet, R.M., et al: Thoracic-Outlet Syndrome: Evaluation of a Therapeutic Exercise Program , Proc Mayo Clin 31:281-287 ( (May 2) ) 1956. 3. Murphy, T.: Brachial Neuritis Caused by Pressure of First Rib , Aust Med J 15:582, 1910. 4. Brickner, W.M.: Brachial Plexus Pressure by the Normal First Rib , Ann Surg 85:858, 1927.Crossref 5. Eden, K.C.: The Vascular Complications of Cervical Ribs and First Thoracic Rib Abnormalities , Brit J Surg 27:111-139, 1939-1940.Crossref 6. Falconer, M.A., and Li, F.W.P.: Resection of the First Rib in Costoclavicular Compression of the Brachial Plexus , Lancet 1:59-63 ( (Jan 13) ) 1962.Crossref 7. Clagett, O.T.: Presidential Address: Research and Prosearch , J Thorac Cardiov Surg 44:153-166 ( (Aug) ) 1962. 8. Roos, D.B.: Transaxillary Approach for First Rib Resection to Relieve Thoracic Outlet Syndrome , Ann Surg 163:354-358 ( (March) ) 1966.Crossref 9. Falconer, M.A., and Weddell, G.: Costoclavicular Compression of the Subclavian Artery and Vein , Lancet 245:539, 1943.Crossref 10. Willshire, W.H.: Supernumerary First Rib: Clinical Records , Lancet 2:633, 1860. 11. Wright, J.S.: The Neurovascular Syndrome Produced by Hyperabduction of the Arms , Amer Heart J 29:1-19, 1945.Crossref 12. Gage, M., and Parnell, H.: Scalenus Anticus Syndrome , Amer J Surg 73:252-268, 1947.Crossref 13. Todd, T.W.: The Hinder end of the Brachial Plexus in Man and Mammals , Anat Anz 41:129, 1912. 14. Telford, E.D., and Stopford, J.S.B.: The Vascular Complications of Cervical Rib , Brit J Surg 18:557, 1930-1931.Crossref 15. Lang, E.K.: Neurovascular Compression Syndromes , Dis Chest 50:572-580 ( (Dec) ) 1966.Crossref 16. Winsor, T., and Brow, R.: Costoclavicular Syndrome , JAMA 196:697-699 ( (May 23) ) 1966.Crossref 17. Annersten, S.: Studies on the Scalenus Anticus Syndrome , Acta Chir Scand 95:419-439, 1947. 18. Gilroy, J., and Meyer, J.S.: Compression of the Subclavian Artery as a Cause of Ischaemic Brachial Neuropathy , Brain 86:733-745, 1963.Crossref 19. Stammers, F.A.R.: Pain in the Upper Limb From Mechanisms in the Costoclavicular Space , Lancet 1:603, 1950.Crossref 20. deBruin, T.R.: Costoclavicular Space Enlargement: Eight Methods for Relief of Neurovascular Compression , Int Surg 46:340-360 ( (Oct) ) 1966. 21. Adson, A.W.: Surgical Treatment for Symptoms Produced by Cervical Ribs and the Scalene Anticus Muscle , Surg Gynec Obstet 85:687-700, 1947. 22. Woods, W.W.: Personal Experiences With Surgical Treatment of 250 Cases Cervicobrachial Neurovascular Compression Syndrome , J Int Coll Surg 44:273-283 ( (Sept) ) 1965. 23. Lord, J.W., Jr.: Surgical Management of Shoulder Girdle Syndromes , Arch Surg 60:69-83, 1953.Crossref 24. Roos, D.B., and Owens, J.C.: Thoracic Outlet Syndrome , Arch Surg 93:71-74 ( (July) ) 1966.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Transaxillary First Rib Resection for the Thoracic Outlet Syndrome

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Publisher
American Medical Association
Copyright
Copyright © 1968 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1968.01340060192023
Publisher site
See Article on Publisher Site

Abstract

Abstract THE THORACIC outlet syndrome is a group of neurovascular symptoms in the neck, shoulder, arm, or hand related to compression of the subclavian vessels and brachial plexus. This condition has been recognized under a variety of names, the most familiar of which is the scalenous anticus syndrome.1 In 1956, Peet et al suggested the term "thoracic outlet compression syndrome" to include all of the recognized syndromes which are related to pressure on the neurovascular structures supplying the upper extremity.2 Scalenotomy has been the most popular surgical therapy until recently. Because of the significant failure rate with scalenotomy, attention has currently shifted to removal of the first rib. Resection of this rib for relief of neurovascular compression dates back to 1910.3 Scattered reports of good results from first rib resection appeared in the literature during the ensuing 50 years but received little attention.4-6 In 1962, Clagett revived References 1. Ochsner, A.; Gage, M.; and DeBakey, M.: Scalenus Anticus (Naffziger) Syndrome , Amer J Surg 28:669-695, 1935.Crossref 2. Peet, R.M., et al: Thoracic-Outlet Syndrome: Evaluation of a Therapeutic Exercise Program , Proc Mayo Clin 31:281-287 ( (May 2) ) 1956. 3. Murphy, T.: Brachial Neuritis Caused by Pressure of First Rib , Aust Med J 15:582, 1910. 4. Brickner, W.M.: Brachial Plexus Pressure by the Normal First Rib , Ann Surg 85:858, 1927.Crossref 5. Eden, K.C.: The Vascular Complications of Cervical Ribs and First Thoracic Rib Abnormalities , Brit J Surg 27:111-139, 1939-1940.Crossref 6. Falconer, M.A., and Li, F.W.P.: Resection of the First Rib in Costoclavicular Compression of the Brachial Plexus , Lancet 1:59-63 ( (Jan 13) ) 1962.Crossref 7. Clagett, O.T.: Presidential Address: Research and Prosearch , J Thorac Cardiov Surg 44:153-166 ( (Aug) ) 1962. 8. Roos, D.B.: Transaxillary Approach for First Rib Resection to Relieve Thoracic Outlet Syndrome , Ann Surg 163:354-358 ( (March) ) 1966.Crossref 9. Falconer, M.A., and Weddell, G.: Costoclavicular Compression of the Subclavian Artery and Vein , Lancet 245:539, 1943.Crossref 10. Willshire, W.H.: Supernumerary First Rib: Clinical Records , Lancet 2:633, 1860. 11. Wright, J.S.: The Neurovascular Syndrome Produced by Hyperabduction of the Arms , Amer Heart J 29:1-19, 1945.Crossref 12. Gage, M., and Parnell, H.: Scalenus Anticus Syndrome , Amer J Surg 73:252-268, 1947.Crossref 13. Todd, T.W.: The Hinder end of the Brachial Plexus in Man and Mammals , Anat Anz 41:129, 1912. 14. Telford, E.D., and Stopford, J.S.B.: The Vascular Complications of Cervical Rib , Brit J Surg 18:557, 1930-1931.Crossref 15. Lang, E.K.: Neurovascular Compression Syndromes , Dis Chest 50:572-580 ( (Dec) ) 1966.Crossref 16. Winsor, T., and Brow, R.: Costoclavicular Syndrome , JAMA 196:697-699 ( (May 23) ) 1966.Crossref 17. Annersten, S.: Studies on the Scalenus Anticus Syndrome , Acta Chir Scand 95:419-439, 1947. 18. Gilroy, J., and Meyer, J.S.: Compression of the Subclavian Artery as a Cause of Ischaemic Brachial Neuropathy , Brain 86:733-745, 1963.Crossref 19. Stammers, F.A.R.: Pain in the Upper Limb From Mechanisms in the Costoclavicular Space , Lancet 1:603, 1950.Crossref 20. deBruin, T.R.: Costoclavicular Space Enlargement: Eight Methods for Relief of Neurovascular Compression , Int Surg 46:340-360 ( (Oct) ) 1966. 21. Adson, A.W.: Surgical Treatment for Symptoms Produced by Cervical Ribs and the Scalene Anticus Muscle , Surg Gynec Obstet 85:687-700, 1947. 22. Woods, W.W.: Personal Experiences With Surgical Treatment of 250 Cases Cervicobrachial Neurovascular Compression Syndrome , J Int Coll Surg 44:273-283 ( (Sept) ) 1965. 23. Lord, J.W., Jr.: Surgical Management of Shoulder Girdle Syndromes , Arch Surg 60:69-83, 1953.Crossref 24. Roos, D.B., and Owens, J.C.: Thoracic Outlet Syndrome , Arch Surg 93:71-74 ( (July) ) 1966.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Dec 1, 1968

References