Nerve and arterial injury after first rib resection

Surgery for Thoracic Outlet Syndrome (TOS) is associated with potential injuries. The thoracic inlet, where surgery for neurogenic, venous, and arterial TOS is performed, is a compact anatomic region containing the brachial plexus, phrenic nerve, long thoracic nerve, subclavian vein and artery, and pleura of the lung. The nature of injury is often related to the specific operation performed, and neurovascular injuries following thoracic outlet decompression are much more likely to result in disability than such an injury in the lower extremity. Paramount to preventing injuries to the neurovascular bundle of the upper extremity and associated structures is a thorough understanding of the region's anatomy along with knowledge of common and uncommon variants.