First rib resection for the thoracic outlet syndrome.

Review of a personal series of 25 first rib resections for thoracic outlet syndrome shows that operation offers a 60% chance of improvement for an acceptable morbidity. This series is the first to consist solely of patients operated on for brachial plexus compression and diagnosed by stated criteria, which were: (1) pain and paraesthesiae running down the arm into the fingers (usually ulnar, but not exclusively); (2) reproduction of distal symptoms by pulling the shoulder down and back, and/or straight down, and/or forwards; (3) pressure in the supraclavicular fossa over the brachial plexus is painful and may reproduce the distal symptoms; and (4) a normal radiculogram.