Removal of the first rib in thoracic outlet syndrome - Is it helpful? Is it dangerous?

A thoracic outlet syndrome is only rarely caused by osseous anomalies. Instead, it is a soft-tissue disease, where the C8 and T1 roots or the proximal inferior trunk of the brachial plexus are compressed by fibromuscular anomalies between the inferior cervical spine and the first rib or pleura. Thoracic outlet syndrome is a clinical diagnosis. If surgery is recommended, it should be concentrated on the fibromuscular anomalies and not on the first rib. Transaxillary removal of the first rib carries an important risk of serious complications. Among these, brachial plexus injury is the most frequent one.