Syndrome of the narrow superior thoracic aperture. Thoracic outlet syndrome

: The neurovascular compression syndromes of the thoracic outlet are mainly characterised by pressure lesion of the brachial plexus and secondly in addition by vascular damages. An indication for surgery exists in cases of persistent or progressive complaints, loss of function of shoulder, arm or hand musculature as well as occurrence of vascular damage. The treatment of choice consists of transaxillary resection of the first rib. Irreversible vascular damage requires additional vascular surgery. Within 5 years 31 operations were performed in 27 patients with a thoracic outlet syndrome. Eleven patients became completely free of symptoms, nine showed clear-cut improvement. Four patients reported lack of improvement. Deterioration was seen in three patients. Preoperative atrophy of small hand muscles is associated with lack of complete functional restitution of nerves and muscles. Predominance of vascular symptoms permits complete restitution to be expected. Results in cases with predominantly neurological symptoms are unsatisfactory.