Surgical management of the thoracic outlet compression syndrome
There is some disagreement about whether thefirst rib should be excised in the presence of a cervical rib for the relief of the thoracic outlet compression syndrome (TOCS). Over a 14-year period (197.5-1988) 58 patients have undergone surgery for TOCS. Forty-four patients (76per cent) had vascular symptoms, 28 (48per cent) with a neurological component; I I (19 per cent) had only neurological symptoms. Thirty-six patients (62 per cent) had the first rib excised; 19 (33 per cent) had a cervical rib excised; two (3 per cent) had a division offibrous bands; and one patient had a large transverse process resected. Follow-up details were available on 53 patients (91 per cent). Overall 38 (72 per cent) were cured of their symptoms, I1 (21 per cent) had a signiJicant improvement, and four (8 per cent) showed no improvement. There was no significant diflerence between the results following excision of a cervical rib or of afirst rib in terms of relief of symptoms. In patients with TOCS who have a cervical rib, excision of the cervical rib alone without excision of the j r s t rib would appear to be an appropriate treatment.
Thoracic outlet compression syndrome (TOCS) presents with symptoms resulting from pressure on either the subclavian vessels or the lower trunk of the brachial plexus. The surgical relief of TOCS by excision of a cervical rib was first described in 1861' and subsequently by excision of the first rib in 1903'. Controversy exists as to which of these is the more beneficial in the treatment ofsymptoms in the presence of a cervical rib3-5. This paper describes an experience of treating 58 patients (66 limbs) with TOCS.