SCALENECTOMY VERSUS 1ST RIB RESECTION FOR TREATMENT OF THE THORACIC OUTLET SYNDROME

  • 1 January 1979
    • journal article
    • research article
    • Vol. 85  (1) , 109-121
Abstract
A previously reported follow-up study of 1st rib resections disclosed a recurrence rate of > 15%. Many patients were reexplored supraclavicularly, and in every case the anterior scalene muscle was reattached to the bed of the 1st rib. Scalenectomy invariably was successful and was studied as the 1st operation for all cases of persistent thoracic outlet syndrome (TOS). Most patients with TOS had a history of neck trauma and symptoms of paresthesias of the hands, weakness of the arms, neck pains and headaches. Common physical findings were tenderness over the scalene muscles and duplication of symptoms with the arms raised. Scalene muscle block with a local anesthesic was the most useful diagnostic test. Good-to-excellent long-term results following 239 scalenectomies and 214 first rib resections were almost identical, 68 and 70%, respectively, with fair results in 20 and 13%, respectively. In patients with a history of neck trauma followed by headache, neck pain, arm weakness and paresthesias in the hand, anterior and middle scalenectomy should be considered. First rib resection is recommended for patients with no history of neck trauma and symptoms limited to the arm and hand, particularly those with signs of arterial or venous insufficiency.

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