Management of the Thoracic-Outlet Syndrome

THORACIC-outlet syndrome refers to compression of the subclavian vessels and brachial plexus at the superior aperture of the thorax. It was previously designated according to presumable etiologies such as scalenus anticus, costoclavicular, hyperabduction, cervical rib and first-thoracic-rib syndromes. Wider clinical recognition of this syndrome can be attributed to improved methods of diagnosis and therapy. The determination of ulnar-nerve conduction velocity (UNCV) for objective evaluation of compression has improved diagnosis, selection of treatment and assessment of therapeutic results. Surgical therapy is currently directed toward extirpation of the first rib, the common denominator for most of the compression mechanisms (Fig. 1).Diagnosis . . .