{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T20:48:05Z","timestamp":1760647685824,"version":"3.41.2"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2022,9,12]],"date-time":"2022-09-12T00:00:00Z","timestamp":1662940800000},"content-version":"vor","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,9,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p\/>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>We have hypothesized that an endoscopically assisted transaxillary approach in the zero position would be able to improve visualization and allow safe surgery for thoracic outlet syndrome.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>We performed surgery only for patients with certain objective findings, including blood flow disruption, low blood flow and accelerated blood flow in the subclavian artery demonstrated using Doppler sonography, narrowing of the scalene interval width between the anterior and middle interscalene muscles (interscalene base) or costoclavicular space demonstrated using Duplex ultrasonography or computed tomography angiography. The present study included 45 consecutive patients (50 limbs) who underwent endoscopic transaxillary first rib resection with scalenotomy and brachial plexus neurolysis. We assessed the intraoperative parameters, including the interscalene base, blood loss, operation time, patient satisfaction, preoperative and postoperative Quick Disability of the Arm, Shoulder and Hand and complications.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>The mean intraoperatively measured interscalene base width was 6.4\u2009mm. All patients showed improvement after surgery. The outcome was excellent in 40% of cases, good in 48%, fair in 12% and poor in none. Pneumothorax was present in 6%. There were no other complications and no recurrences. Among patients who had been followed up for at least 2\u2009years, the Quick Disability of the Arm, Shoulder and Hand score was significantly improved (42 before surgery vs 12 at final follow-up), especially in athletes relative to non-athletes (0.2 vs 16). The present approach achieved complete relief in 43% of cases overall (91% in athletes and 16% in non-athletes).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Endoscopically assisted transaxillary first rib resection and brachial plexus neurolysis in the zero position are useful and safe for thoracic outlet syndrome, especially in athletes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/icvts\/ivac239","type":"journal-article","created":{"date-parts":[[2022,9,12]],"date-time":"2022-09-12T15:53:21Z","timestamp":1662998001000},"source":"Crossref","is-referenced-by-count":3,"title":["Midterm results of endoscopically assisted first rib resection in the zero position for thoracic outlet syndrome"],"prefix":"10.1093","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3500-5755","authenticated-orcid":false,"given":"Hiroshi","family":"Satake","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine , Yamagata, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8301-6953","authenticated-orcid":false,"given":"Ryusuke","family":"Honma","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine , Yamagata, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshiya","family":"Nito","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine , Yamagata, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4407-1479","authenticated-orcid":false,"given":"Yasushi","family":"Naganuma","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine , Yamagata, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9177-7784","authenticated-orcid":false,"given":"Junichiro","family":"Shibuya","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine , Yamagata, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1339-0023","authenticated-orcid":false,"given":"Masahiro","family":"Maruyama","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine , Yamagata, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3389-5272","authenticated-orcid":false,"given":"Tomohiro","family":"Uno","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine , Yamagata, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3052-787X","authenticated-orcid":false,"given":"Michiaki","family":"Takagi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine , Yamagata, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,9,12]]},"reference":[{"key":"2022092120532658200_ivac239-B1","first-page":"CD007218","article-title":"Treatment for thoracic outlet syndrome","volume":"26","author":"Povlsen","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"2022092120532658200_ivac239-B2","first-page":"461","article-title":"Brachial pressure neuritis due to a normal first thoracic rib: its diagnosis and treatment by excision of rib","volume":"42","author":"Morley","year":"1913","journal-title":"Clin J"},{"key":"2022092120532658200_ivac239-B3","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1097\/00000658-192785060-00005","article-title":"Cervical rib: a method of anterior approach for relief of symptoms by division of the scalenus anticus","volume":"85","author":"Adson","year":"1927","journal-title":"Ann Surg"},{"key":"2022092120532658200_ivac239-B4","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/S0140-6736(62)91716-6","article-title":"Resection of the first rib in costoclavicular compression of the brachial plexus","volume":"1","author":"Falconer","year":"1962","journal-title":"Lancet"},{"key":"2022092120532658200_ivac239-B5","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1001\/archsurg.1966.01330010073010","article-title":"Thoracic outlet syndrome","volume":"93","author":"Roos","year":"1966","journal-title":"Arch Surg"},{"key":"2022092120532658200_ivac239-B6","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1016\/j.jamcollsurg.2014.12.046","article-title":"A decade of excellent outcomes after surgical intervention in 538 patients with thoracic outlet syndrome","volume":"220","author":"Orlando","year":"2015","journal-title":"J Am Coll Surg"},{"key":"2022092120532658200_ivac239-B7","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1016\/0741-5214(89)90005-0","article-title":"The treatment of thoracic outlet syndrome: a comparison of different operations","volume":"10","author":"Sanders","year":"1989","journal-title":"J Vasc Surg"},{"key":"2022092120532658200_ivac239-B8","doi-asserted-by":"crossref","first-page":"416.e1","DOI":"10.1016\/j.jhsa.2018.06.120","article-title":"Outcomes of surgical management of neurogenic thoracic outlet syndrome: a systematic review and Bayesian perspective","volume":"44","author":"Yin","year":"2019","journal-title":"J Hand Surg Am"},{"key":"2022092120532658200_ivac239-B9","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1510\/icvts.2007.151423","article-title":"Endoscopic assisted transaxillary first rib resection","volume":"6","author":"Abdellaoui","year":"2007","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2022092120532658200_ivac239-B10","doi-asserted-by":"crossref","first-page":"e155","DOI":"10.1016\/j.asmr.2020.08.019","article-title":"Endoscopic-assisted transaxillary approach for first rib resection in thoracic outlet syndrome","volume":"3","author":"Furushima","year":"2021","journal-title":"Arthrosc Sports Med Rehabil"},{"key":"2022092120532658200_ivac239-B11","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.athoracsur.2016.06.075","article-title":"Totally endoscopic (VATS) first rib resection for thoracic outlet syndrome","volume":"103","author":"George","year":"2017","journal-title":"Ann Thorac Surg"},{"key":"2022092120532658200_ivac239-B12","doi-asserted-by":"crossref","first-page":"3250","DOI":"10.1007\/s00268-018-4636-4","article-title":"First rib resection for thoracic outlet syndrome: the robotic approach","volume":"42","author":"Kocher","year":"2018","journal-title":"World J Surg"},{"key":"2022092120532658200_ivac239-B13","doi-asserted-by":"crossref","first-page":"2022","DOI":"10.21037\/jtd.2017.06.122","article-title":"Video-assisted thoracoscopic surgery for intrathoracic first rib resection in thoracic outlet syndrome","volume":"9","author":"Hwang","year":"2017","journal-title":"J Thorac Dis"},{"key":"2022092120532658200_ivac239-B14","doi-asserted-by":"crossref","first-page":"139","DOI":"10.3109\/03093648409146075","article-title":"\u201cZero-position\u201d functional shoulder orthosis","volume":"8","author":"Ozaki","year":"1984","journal-title":"Prosthet Orthot Int"},{"key":"2022092120532658200_ivac239-B15","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1016\/0002-9610(76)90456-6","article-title":"Congenital anomalies associated with thoracic outlet syndrome. Anatomy, symptoms, diagnosis, and treatment","volume":"132","author":"Roos","year":"1976","journal-title":"Am J Surg"},{"key":"2022092120532658200_ivac239-B16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/0002-8703(45)90593-X","article-title":"The neurovascular syndrome produced by hyperabduction of the arms: the immediate changes produced in 150 normal controls, and the effects on some persons of prolonged hyperabduction of the arms, as in sleeping, and in certain occupations","volume":"29","author":"Wright","year":"1945","journal-title":"Am Heart J"},{"key":"2022092120532658200_ivac239-B17","doi-asserted-by":"crossref","first-page":"623","DOI":"10.2214\/ajr.158.3.1739007","article-title":"Thoracic outlet syndrome: evaluation of the subclavian vessels by color duplex sonography","volume":"158","author":"Longley","year":"1992","journal-title":"AJR Am J Roentgenol"},{"key":"2022092120532658200_ivac239-B18","doi-asserted-by":"crossref","first-page":"795","DOI":"10.7863\/jum.2001.20.7.795","article-title":"Color Doppler and duplex sonography in 5 patients with thoracic outlet syndrome","volume":"20","author":"Wadhwani","year":"2001","journal-title":"J Ultrasound Med"},{"key":"2022092120532658200_ivac239-B19","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/j.jmpt.2012.04.017","article-title":"Descriptive anatomy of the interscalene triangle and the costoclavicular space and their relationship to thoracic outlet syndrome: a study of 60 cadavers","volume":"35","author":"Dahlstrom","year":"2012","journal-title":"J Manipulative Physiol Ther"},{"key":"2022092120532658200_ivac239-B20","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1007\/s11552-013-9523-8","article-title":"Dynamic neuromusculoskeletal ultrasound documentation of brachial plexus\/thoracic outlet compression during elevated arm stress testing","volume":"8","author":"Fried","year":"2013","journal-title":"Hand (N Y)"},{"key":"2022092120532658200_ivac239-B21","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1016\/j.jmpt.2016.08.002","article-title":"Reference values for the scalene interval width during varying degrees of glenohumeral abduction using ultrasonography","volume":"39","author":"Mattox","year":"2016","journal-title":"J Manipulative Physiol Ther"},{"key":"2022092120532658200_ivac239-B22","doi-asserted-by":"crossref","first-page":"1667","DOI":"10.2214\/ajr.174.6.1741667","article-title":"Helical CT angiography of thoracic outlet syndrome: functional anatomy","volume":"174","author":"Remy-Jardin","year":"2000","journal-title":"AJR Am J Roentgenol"},{"key":"2022092120532658200_ivac239-B23","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.avsg.2020.09.060","article-title":"Normal costoclavicular distance as a standard in the radiological evaluation of thoracic outlet syndrome in the costoclavicular space","volume":"72","author":"Duarte","year":"2021","journal-title":"Ann Vasc Surg"},{"key":"2022092120532658200_ivac239-B24","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1097\/00000658-196603000-00005","article-title":"Transaxillary approach for first rib resection to relieve thoracic outlet syndrome","volume":"163","author":"Roos","year":"1966","journal-title":"Ann Surg"},{"key":"2022092120532658200_ivac239-B25","first-page":"1038","article-title":"Development of the QuickDASH: comparison of three item-reduction approaches","volume":"87","author":"Beaton","year":"2005","journal-title":"J Bone Joint Surg Am"},{"key":"2022092120532658200_ivac239-B26","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.3928\/0147-7447-19810901-08","article-title":"The results of first rib resection in thoracic outlet syndrome","volume":"4","author":"Derkash","year":"1981","journal-title":"Orthopedics"},{"key":"2022092120532658200_ivac239-B27","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1007\/s12178-020-09643-x","article-title":"Thoracic outlet syndrome in the overhead athlete: diagnosis and treatment recommendations","volume":"13","author":"Ohman","year":"2020","journal-title":"Curr Rev Musculoskelet Med"},{"key":"2022092120532658200_ivac239-B28","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1016\/0967-2109(96)82859-6","article-title":"Neurogenic thoracic outlet decompression: rationale for sparing the first rib","volume":"3","author":"Cheng","year":"1995","journal-title":"Cardiovasc Surg"},{"key":"2022092120532658200_ivac239-B29","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.avsg.2018.05.049","article-title":"Comparison of athletes and nonathletes undergoing thoracic outlet decompression for neurogenic thoracic outlet syndrome","volume":"54","author":"Beteck","year":"2019","journal-title":"Ann Vasc Surg"},{"key":"2022092120532658200_ivac239-B30","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1007\/s004649901141","article-title":"Port-access first-rib resection","volume":"13","author":"Ohtsuka","year":"1999","journal-title":"Surg Endosc"}],"container-title":["Interactive CardioVascular and Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/icvts\/advance-article-pdf\/doi\/10.1093\/icvts\/ivac239\/45800464\/ivac239.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/35\/4\/ivac239\/45960614\/ivac239.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/35\/4\/ivac239\/45960614\/ivac239.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,21]],"date-time":"2022-09-21T21:19:05Z","timestamp":1663795145000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/icvts\/article\/doi\/10.1093\/icvts\/ivac239\/6696242"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,9]]},"references-count":30,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022,9,9]]}},"URL":"https:\/\/doi.org\/10.1093\/icvts\/ivac239","relation":{},"ISSN":["1569-9285"],"issn-type":[{"type":"electronic","value":"1569-9285"}],"subject":[],"published-other":{"date-parts":[[2022,10,1]]},"published":{"date-parts":[[2022,9,9]]},"article-number":"ivac239"}}