http://www.vascularweb.org/_CONTRIBU...s/Cassada.html ......Beth, I remembered this very interesting David Cassada report from 2004.

"Dr Johansen’s operative approach to brachial plexus relief involved a standard supraclavicular approach with anterior scalene muscle resection brachial plexus neurolysis and segmental first rib resection12. He also advocated the addition of the release of the pectoralis minor muscle to divest the cords of the brachial plexus as they pass under the corocoid process, a second sight of nerve compression associated historically with the upper extremity “hyperabduction syndrome.” His experience with this technique was first developed as an adjunct to reoperation for TOS and he has now selectively incorporated it as a part of the primary operation for neurogenic TOS. His is currently collecting outcomes data relating to this combination therapy."