Muhammad Imran, Abdul Baseer, Aamir Bilal, Manzoor Ahmad


Objective: To evaluate the outcome of scalenotomy with cervical rib excision
for Thoracic outlet syndrome (TOS).
Design: Retrospective observational descriptive study.
Place and Duration: Department of Thoracic Surgery Postgraduate Medical
Institute, Govt. Lady Reading Hospital Peshawar from June 2007 to June 2014.
Material and Methods: Computerized clinical record of diagnosed cases of thoracic outlet syndrome presented in our unit for treatment was retrospectively analyzed. Nerve conduction study was done in all cases. Vascular thoracic outlet syndrome was excluded from the study. The indication of surgery in all patients was persistent neurogenic symptoms after trial of conservative physical therapy.  Scalenotomy with cervical rib excision through supraclavicular approach was carried out. The outcome of the procedure was assessed according to Derkash`s classification as excellent, good, fair and poor in terms of clinical improvement in the symptoms of TOS and nerve conduction study.

Results: Out of total 72 patients 56 (77.78%) were females and16 (22.23 %) males. Age ranged from 22 years to 49 years with mean age of 33.2 years. Thirty four (47.22%) patients underwent scalenotomy with cervical rib excision and 38 (52.7%) patients had scalenotomy only. The minimum follow up was 6 month. At 6 months after surgery, according to Derkash's classification and nerve conduction study 54 (75%) have excellent, 14 (19.4%) have good, 3 (4.16%) have fair and one (1.38%) patient had Poor result. At 6 months follow up no recurrence of symptoms had occurred. Eight (11.11%) post operative complications occurred. Four patients had wound site haematoma which responded to local drainage while 3 patients had minor wound infections which were treated conservatively and one patient had pneumothorax which was managed by chest intubation. Post operative mortality was zero.

CONCLUSION: Scalenotomy with cervical rib excision is sufficient to relieve the symptoms of neurogenic TOS without excision of the first rib. Supraclavicular incision is an easy and appropriate approach for scalenotomy with cervical rib excision.


Thoracic Outlet Syndrome; Cervical Rib; Scalenotomy; Supra Clavicular Approach

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