Surgical treatment of the thoracic outlet compression syndrome.

Narrowing of the thoracic outlet may give rises to symptoms in the arm from compression of the nerves, the subclavian artery, and the subclavian vein. Anatomic studies show that nerve compression may affect fibers from T-1, C-8, and not infrequently C-7, providing an explanation for the diffuse nature of the nerve symptoms in the arm. Relief from this compression at the thoracic outlet is readily accomplished by transaxillary resection of the first rib together with any associated cervical rib, fibrous cervical rib analogues, or other fibrous bands encroaching on the neurovascular structures. A study of 40 patients with the syndrome who were treated in this way and followed up after an interval of three to ten years shows that those with nerve and vein symptoms can expect a good result but the results of treatment in those with arterial symptoms is less satisfactory.