Twelve patients with thoracic syndrome were operated during a 15 month period. Eleven patients had features of neurogenic thoracic outlet syndrome, while one presented with arterial ischemia due to distal embolism. The diagnosis was based on tbe characteristic history and positive stress tests. Cervical rib was present in 7 patients. Abnormal nerve conduction studies were present in 7 out of 8 cases. Supraclavicular first rib resection was done in all patients in view of the severity of symptoms. If present, the cervical rib was also excised. There was no major operative complication. Eleven out of twelve patients reported relief of symptoms. Thoracic outlet syndrome is not an uncommon disorder and often goes undiagnosed. Resection of first rib via the supraclavicular approach gives good results in majority oftbe patients who have incapacitating symptoms. MJAF11996; 52 : 83-86 KEY WORDS: Thoracic outlet syndrome; Cervical rib syndrome.