The thoracic outlet syndrome is a syndrome caused by compression of the brachial plexus and subclavian vessels around the thoracic outlet surrounded by the first rib on both sides. According to the causes of this syndrome, it can be divided into the following five categories: cervical rib syndrome; anterior oblique angle syndrome; rib lock syndrome; 1st rib syndrome; excessive abduction syndrome” The cervical rib and anterior oblique angle muscle syndrome is the most common, the pathogenesis of the two! The clinical symptoms and management are similar, but the difference is that the former has a cervical rib while the latter does not have a cervical rib and its fibrous band or cartilage. The cervical rib and its fibrous band or cartilage may reduce the posterior gap between the brachial plexus and the subclavian artery, or elevate the brachial plexus above it, and as the cervical rib or its fibrous band crosses this gap, the lower trunk of the brachial plexus and the subclavian artery may be abnormally compressed by the cervical rib or its fibrous band and the anterior oblique muscle, causing symptoms. In some patients, although there is no cervical rib, but because of the hypertrophy of the anterior oblique muscle, or because of the lower end of the middle oblique muscle to form a forward extension of the expansion, so that the first rib moved up, the gap of the anterior oblique muscle becomes smaller, resulting in compression of the brachial plexus and subclavian artery. The pain department of Tianjin Port Hospital, Zhao Xinhua 1. Clinical manifestations: mainly the symptoms manifested by the compression of the brachial plexus and subclavian artery. (1) Nerve compression: the affected side of the neck and shoulder feels sore and weak or has tingling, burning and numbness, and the neck pain and numbness spreads to the elbow, forearm and ulnar side of the hand. The main manifestations are paralysis of the interosseous muscle and small interosseous muscle, with varying degrees of muscle atrophy, and in a few cases, loss of muscle strength in the large interosseous or forearm, and sensory impairment in the ulnar side of the forearm and hand. In most cases, the anterior oblique muscle tension test is positive, and the test is performed by turning the head to the healthy side, hyperextending the neck, and pulling the affected arm downward at the same time, and the numbness and pain of the affected limb increases and radiates to the distal side, which is positive. (2) Vascular compression manifestations: generally no serious circulatory disorders in the affected limb, only some cases feel cold in the affected hand “When the two hands are raised, the affected hand becomes white, the temperature drops, the radial artery becomes weak or can not be felt, when the two hands are lowered obviously congested” Adson test is an examination method to find out whether the blood vessels are under pressure “The method is as follows: the patient sits upright, both hands are placed on the knee, the head is turned to the healthy side, the lower jaw is raised, the neck is extended back” The patient is asked to (3) Local manifestations: the affected supraclavicular fossa is full, most patients can palpate the anterior oblique muscle tension hypertrophy, with cervical ribs can be palpated bony bulge, and there is local pressure pain and radiating pain to the affected limb. (4) X-ray examination: cervical ribs can be shown in those with cervical ribs “and cervical disc herniation and cervical spondylosis: mainly cervical disc herniation and cervical spondylosis without signs of vascular compression”, in addition, there is often pressure pain in the spinous process of the cervical spine or paraspinal, positive pressure neck test, X-ray film shows narrowing of the cervical space and degenerative changes “MRI or CT manifestation of cervical disc herniation! Spinal stenosis or ossification of the posterior longitudinal ligament. 2.Surgical treatment is suitable for those whose symptoms do not improve or even worsen after 1~3 months of non-surgical treatment, whose ulnar nerve conduction velocity is less than 60m/s through the thoracic outlet; whose angiography shows obvious narrowing and obstruction of subclavian artery and vein; and whose symptoms of severe local pain or venous compression are significant. The principle of surgery is to release the bony scissor-like compression of the vascular nerve bundle. The full length of the first rib must be amputated and the relevant compression factors must be released so that the brachial plexus and subclavian artery can be moved down without producing deformity complications.