Abstract:The clinical and other relevant factors of 126 cases of thoracic outlet syndrome (TOS) are analyzed. A new clinical grading system is introduced, as well as a new classification of TOS based on clinical findings, neuroelectric tests results, stress tests, and radiographic data. The surgical technique of the anterior supraclavicular approach is described in detail, with emphasis on the ways and means of dealing with the normal and many anomalous structures encountered in 142 operations. The good outcome and infrequent complications of this diagnostic and management approach to TOS argue strongly for the author's recommendations of stringent patient selection for surgery and painstaking regards to details during surgery.