All of the following may be acceptable operative approaches to management of the thoracic outlet syndrome except:

C. Thoracoplasty.

DISCUSSION: Supraclavicular decompression of the thoracic outlet is the preferred operative approach for the thoracic outlet syndrome. This procedure consists of extensive anterior scalenectomy, middle scalenectomy, removal of a cervical rib (if present), and, on occasion, first rib resection. Transaxillary first rib resection has been widely used as well but is associated with a greater risk for complications. Numerous fibromuscular anomalies have been described in association with the thoracic outlet syndrome. Thoracoplasty has no role in the management of this disorder.