ISAKOS: 2019 Congress in Cancun, Mexico

2019 ISAKOS Biennial Congress ePoster #1905


Clinical Outcome of Arthroscopic-Assisted Trans-Axillary First Rib Resection for Thoracic Outlet Syndrome

Yusuke Iwahori, MD, PhD, Prof., Kasigai, Aichi-Ken JAPAN
Yohei Harada, MD, PhD, Nagakute, Aichi-ken JAPAN
Masataka Deie, MD, PhD, Prof., Nagakute, Aichi-Ken JAPAN

Dept. of Orthopaedic Surgery, Aichi Medical University School of Medicine, Nagakute, Aichi-ken, JAPAN

FDA Status Cleared


We investigated clinical outcomes of arthroscopic-assisted trans-axillary first rib resection for refractory thoracic outlet syndrome.



The purpose of this study is to investigate clinical outcomes of arthroscopic-assisted trans-axillary first rib resection (ATAFR) for refractory thoracic outlet syndrome (TOS).


Open trans-axillary first rib resection is one of conventional surgical procedures for TOS. However that procedure is difficult to achieve good surgical field. Then we developed ATAFR technique and performed on the TOS cases resistant to conservative treatment more than 3 months.


In lateral decubitus position with the arm 100 degree abducted position, pectoralis major – latissimus dorsi interval was divided and the anterior and middle scalene muscles on the 1st rib were dissected under direct vision. After that, 4mm arthroscope was inserted and scalenotomy and 1st rib resection were performed arthroscopically .We studied 16 cases followed up over 1 year after surgery.


There were 7 males and 9 females with a mean age of 21.5 years old. Twelve cases participated in sports activity. The mean follow up period was 1.8 years (range: 1.1-3.8). Axonal degeneration of C8 or Th1 nerve was showed in all the 11 cases performed needle EMG. Apparent compression of the subclavian artery with the arm elevated position was observed in 8 of 16 cases on MRI or CT angiography. There were two bony abnormality cases (cervical rib, 1st rib fatigue fracture). There existed fibrous band in costo-clavicular interstice or hypertrophy of scalene muscle in all cases. Pneumothorax occurred in 2 cases, resulted full recovery with chest drainage. Post-operative 3D-CT showed the 1st rib was resected enough in all cases. After surgery, all cases gained improvement of TOS symptom, and quick DASH score significantly reduced from preoperative 45.8 to postoperative 17.3. All sports participants could return to sports activity with the complete recovery rate of 57.1%.


ATAFR was useful to provide a good and bright visual field to both of a surgeon and assistants.