First Rib Resection in Thoracic Outlet Syndrome

Siamak Barkhordarian

Most patients with thoracic outlet syndrome (TOS) present with exercise-induced upper extremity paresthesia. Neurogenic TOS is the most common type where the brachial nerve plexus is compressed against a tight thoracic outlet. Vascular compromise although rare can result from thoracic outlet pressure against the subclavian artery or more commonly the subclavian vein. This article reviews the pathophysiology of TOS and describes several effective surgical interventions. The authors suggest that first rib resection via supraclavicular or a preferred transaxillary route should be considered when conservative modalities provide no symptom improvement.

The Journal of Hand Surgery, Volume 32, Issue 4, April 2007, Pages 565-570

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Therapeutic Interventions for the Shoulder

Explore evidence-based interventions for shoulder pain including the Shoulder Symptom Modification Procedure and prescription considerations. Covers clinical approaches to management of specific conditions including instability, rotator cuff and subacromial pain.