Epineurectomy for thoracic outlet syndrome.

The authors' approach to patients with TOS starts with a thorough evaluation, including a detailed history, physical examination, electromyography, and radiographs. Once the work-up is complete a treatment plan is formulated with the patient. All diagnoses are prioritized, together with various options for treatment of each. Therapy is initiated when appropriate and a surgical plan addresses the worst nerve entrapments sequentially. The authors' favored procedure for TOS release is an anterior scalenectomy with epineurectomy, with decompression of any structures impinging on the brachial plexus. The authors encourage patients to attend therapy for approximately 3 months after surgery, and to follow a home program of rehabilitation to maximize their gains and decrease the chance of recurrence.