title: Trans-axillary first rib excision for thoracic outlet syndrome.
abstract: OBJECTIVE
  Thoracic outlet syndrome (TOS) is a clinical diagnosis treatable by excision of the first rib. This study was undertaken to assess the alleviation of symptoms following trans-axillary rib excision in patients with a diagnosis of TOS suggested by a positive Elevated Arm Stress Test and, by inference, to estimate the prevalence of the syndrome.
  
  
  METHODS
  A retrospective review of trans-axillary first rib excision was performed. No referrals were accepted from outwith the catchment area of our hospital. Post-operative symptomatic improvement was accepted as a confirmation of correct pre-operative diagnosis.
  
  
  RESULTS
  Over six years, 52 rib resections were performed in 46 patients, mean age (+/- S.D.) 38.8 (+/- 10.6) years. The indications for surgery were principally neurological symptoms (n = 42 excisions), arterial compromise (n = 5) and venous compromise (n = 5). Symptoms had been present for a mean of 15.8 months prior to surgery. The median follow-up after surgery was 33 months. 42 patients (48 resections) showed immediate improvement in symptoms following surgery, although symptoms recurred in three patients (4 resections) between 6 and 8 months post-operatively. In the final two years of this study, 20 resections resulting in symptomatic improvement were performed, suggesting a prevalence for TOS of at least 10 per 100,000 per year.
  
  
  CONCLUSIONS
  Thoracic outlet decompression was performed more frequently in this series than many previous reports, suggesting that TOS may be under-diagnosed.
authors.affiliation: Department of Surgery, Royal Hospital Haslar, Gosport, Hants, UK.
authors.forename: D P
authors.initials: DP
authors.lastname: Edwards
authors.forename: E
authors.initials: E
authors.lastname: Mulkern
authors.forename: A N
authors.initials: AN
authors.lastname: Raja
authors.forename: P
authors.initials: P
authors.lastname: Barker
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012272:Ribs / Q000601:surgery*; D013901:Thoracic Outlet Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome