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Removal of the First Rib for Thoracic Outlet Syndrome

Posted on: 12/12/2005
Bone or soft tissue in the neck, shoulder, or arm can pinch off major blood vessels and nerves from the neck down the arm. Symptoms of pain, swelling, numbness, tingling, or cold hand and fingers from this problem are called thoracic outlet syndrome (TOS).

In this study from Johns Hopkins University neurosurgeons compare the results of two operations for TOS. One group had a section of the first rib removed. This operation is called a transaxillary first rib resection (TFRR). The second group had a supraclavicular neuroplasty of the brachial plexus (SNBP). This means scar tissue or constricting fibrous bands and muscles were removed from around the nerves.

The goal of both these operations was to take pressure off the blood vessels and nerves. The hope was to relieve pain and other symptoms. The goal of this study was to see which operation worked better. The authors report a significant difference between the two groups.

Three-fourths of the TFRR group (rib resection) reported good-to-excellent results. Less than half the SNBP group had good results. Patients were followed for up to three years and showed the same findings. This is considered a "long-term" result.

Summary: By all measures the TFRR operation was the better treatment for relief of TOS symptoms. The authors conclude the right surgery may be better than letting this problem run its own course.

Rishi N. Sheth, MD and James N. Campbell, MD. Surgical Treatment of Thoracic Outlet Syndrome: A Randomized Trial Comparing Two Operations. In Journal of Neurosurgery: Spine. November 2005. Vol. 3. No. 5. Pp. 355-363.

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