THORACIC OUTLET SYNDROME WITH SPECIAL REFERENCE TO THE FIRST RIB

The thoracic outlet syndrome (TOS) is a highly controversial concept. The incidence of TOS is high in the United States, essentially unknown in Australia and seldom diagnosed in Great Britain, In spite of the s kepticism in the recent medical literature many patients are still sur gically treated with resection of the first rib for a symptom complex diagnosed as TOS. Resection of the first rib is the most extensively u sed surgical approach in the treatment of TOS. This operation gives a good result in 24 % to 100 % of the patients. The reasons for this hug e variation are considered to be related to difficulties in patient se lection, variable examination procedures, operative techniques and a l ack of proper follow-up. The goal or this review is to bring forth the diverging results after first rib resection for TOS and to pinpoint t he importance of further studies concerning the possible functional di sturbance of the thoracic outlet in these patients. Conservatism is en couraged.