First rib resection is a surgical procedure used in humans to treat thoracic outlet syndrome (TOS) and

Paget–Schroetter disease Paget–Schroetter disease (also known as venous thoracic outlet syndrome) is a form of upper extremity deep vein thrombosis (DVT), a medical condition in which blood clots form in the deep veins of the arms. These DVTs typically occur in the axi ...

. It involves the

surgical Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

removal of a segment of the first rib, which is the rib closest to the head, under the

collar bone The clavicle, or collarbone, is a slender, S-shaped long bone approximately 6 inches (15 cm) long that serves as a strut between the shoulder blade and the sternum (breastbone). There are two clavicles, one on the left and one on the righ ...

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Indications

A-case-of-Paget-Schroetter-syndrome-(PSS)-in-a-young-judo-tutor-a-case-report-13256 2016 848 Fig1 HTML

First rib resection is indicated for

venous Veins are blood vessels in humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated ...

arterial An artery (plural arteries) () is a blood vessel in humans and most animals that takes blood away from the heart to one or more parts of the body (tissues, lungs, brain etc.). Most arteries carry oxygenated blood; the two exceptions are the pu ...

, and

neurogenic In biology, the nervous system is the highly complex part of an animal that coordinates its actions and sensory information by transmitting signals to and from different parts of its body. The nervous system detects environmental changes ...

TOS. In all cases, the goal of the operation is to increase the dynamic space between the chest wall and the

clavicle The clavicle, or collarbone, is a slender, S-shaped long bone approximately 6 inches (15 cm) long that serves as a strut between the shoulder blade and the sternum (breastbone). There are two clavicles, one on the left and one on the r ...

, through which the subclavian vein, artery, and the brachial nerve roots pass.

Procedure

The first rib may be approached several different ways: from above the clavicle in an inferior direction (infraclavicular), from above the

(supraclavicular), from the posterior neck, and from the

armpit The axilla (also, armpit, underarm or oxter) is the area on the human body directly under the shoulder joint. It includes the axillary space, an anatomical space within the shoulder girdle between the arm and the thoracic cage, bounded superior ...

medially (transaxillary). While the operation universally involves removal of the first rib, depending on the indication for the operation, additional maneuvers may be performed. For venous thoracic outlet syndrome, removal of

anterior scalene muscle The scalene muscles are a group of three pairs of muscles in the lateral neck, namely the anterior scalene, middle scalene, and posterior scalene. They are innervated by the third to the eight cervical spinal nerves (C3-C8). The anterior and ...

(scalenectomy) and freeing up scar tissue around the subclavian vein (venolysis) are often also performed. If anomalous

cervical In anatomy, cervical is an adjective that has two meanings: # of or pertaining to any neck. # of or pertaining to the female cervix: i.e., the ''neck'' of the uterus. *Commonly used medical phrases involving the neck are **cervical collar **cerv ...

ribs are present, these may be removed as well.

References

{{Vascular procedures , state=expanded Surgical procedures and techniques