First rib resection for neurovascular syndromes of the thoracic outlet.

During the first half of this century, various syndromes attributed to compression of neural and vascular structures in the anatomic area of the thoracic outlet have been described. These include the cervical rib, scalene anticus, costoclavicular, first dorsal rib, and hyperabduction syndromes. This complex array of subdivisions has engendered some confusion in diagnosis and treatment. Although no unanimity of opinion can yet be said to exist, several authors have more recently attempted to relate these conditions to a common denominator, that of compression of the neurovascular bundle between first rib and clavicle, with or without presence of a cervical rib. Such a unifying concept of the fundamental mechanical factor involved has led to new surgical approaches to the relief of symptoms associated with this syndrome. It is our purpose to describe the surgical anatomy of first rib resection as it relates to the thoracic outlet.