The supraclavicular approach has been a successful route for thoracic outlet decompression. It permits many more options than the transaxillary route. Anterior and middle scalenectomy, together with brachial plexus neurolysis can be performed with excellent exposure. The same incision can be used to perform cervical or first rib resection, although the success rate is not significantly improved by removing ribs. The 5-year success rate for scalenectomy with or without first rib resection using life table methods is approximately 70%.