Supraclavicular first rib resection

In cases where conservative management has failed to relieve a patient's symptoms of thoracic outlet syndrome, surgical decompression is considered. There are two operative procedures for surgical treatment, including the transaxillary approach for the first-rib resection or a supraclavicular approach for anterior and middle scalenectomies, with or without first-rib resection. The authors describe a supraclavicular approach that allows complete visualization of the neurovascular structures to permit full decompression of the brachial plexus and first rib resection.