Preoperative radiographic and neurophysiologic examinations were also not predictive of the outcome. It is recommended that the feasibility of conservative therapeutic approaches should be evaluated before undertaking surgery for TOS symptoms. There are 5 syndromes involving the thoracic outlet. The study of these four syndromes prepares the reader to that of the controversial fifth syndrome, which is entirely subjective, made only of symptoms. Huge surgical statistics, that deal mostly with resection of the first rib, have not proven the authenticity of this second variety of the 5th syndrome.
Surgeons report only early surgical results, and the results claimed are invariably impressive.
Never is there a statistic about return to work after surgery. First rib resection can be dangerous and it can be complicated by tardy permanent brachial plexopathy. One very recent European study proves the discrepancy between the early appreciation of the results by the surgeon and the late appreciation by independent observers. TOS remains extremely controversial with respect to its existence, diagnosis, conservative management, and surgical treatment. The diagnosis is based upon clinical evaluation, reproduction of patient symptoms with arm elevation, and the absence of other relevant pathology.