Brachial plexus injuries with causalgia resulting from transaxillary rib resection.

In each of four patients with suspected thoracic outlet syndromes, the transaxillary approach to resection of the first thoracic and cervical ribs resulted in severe and permanent damage to the brachial plexus. The most severe sequela was causalgia. Weakness of the hand muscles, sensory deficits, and autonomic dysfunction also occurred. Abuse of narcotic analgesics was common. Two patients suffered severe psychological depressions, with one committing suicide. Current enthusiasm with transaxillary rib resections in cases of thoracic outlet syndrome should be tempered by the possibility of severe and permanent injury to the brachial plexus and intractable causalgia.