Elsevier – Patient Education │Thoracic Outlet Syndrome Surgery

Thoracic outlet syndrome in the shoulder area. There is redness where nerves between the collarbone and neck are squeezed.

Thoracic outlet syndrome surgery consists of one or two procedures to treat thoracic outlet syndrome (TOS). TOS happens when the blood vessels or nerves are squeezed (compressed) in the area between the collarbone and lower neck. The goal of this procedure is to reduce the compression that causes TOS. During TOS surgery, you may have one or both of these procedures done, depending on what needs to be repaired:

Scalenectomy. This is the removal of a muscle that passes through the thoracic outlet (scalene muscle).
Rib resection. This is the removal of a small rib bone near the thoracic outlet.

Tell a health care provider about:

Any allergies you have.
All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
Any problems you or family members have had with anesthetic medicines.
Any blood disorders you have.
Any surgeries you have had.
Any medical conditions you have or have had.
Whether you are pregnant or may be pregnant.
Any recent symptoms of colds or infections.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

Infection.
Bleeding.
Allergic reactions to medicines.
Damage to other structures or organs, such as the lungs or the nerves and blood vessels in the thoracic outlet.
Scar tissue. This may cause symptoms to return.
Worsened symptoms of TOS.

What happens before the procedure?

Medicines

Ask your health care provider about:

Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
Taking over-the-counter medicines, vitamins, herbs, and supplements.

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking

Follow instructions from your health care provider about eating and drinking, which may include:

8 hours before the procedure – stop eating heavy meals or foods, such as meat, fried foods, or fatty foods.
6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
6 hours before the procedure – stop drinking milk or drinks that contain milk.
2 hours before the procedure – stop drinking clear liquids.

Exams and tests

You may have a physical exam.
You may have tests, including:
- Blood tests.
- Urine tests.
- X-rays.
- An MRI.
- A CT scan.
- Electrocardiogram (ECG).
- Electromyogram (EMG).

General instructions

Ask your health care provider:
- How your surgical site will be marked or identified.
- What steps will be taken to help prevent infection. These may include:
  - Washing skin with a germ-killing soap.
  - Taking antibiotic medicine.
Plan to have someone take you home from the hospital or clinic.

What happens during the procedure?

An incision being made above a person's clavicle, with a close-up showing cutting and removal of the scalene muscle.

A person's shoulder area, with a close-up showing the removal of a small rib bone near the thoracic outlet.

An IV will be inserted into one of your veins.
You may be given a medicine to help you relax (sedative).
You will be given a medicine to make you fall asleep (general anesthetic).
An incision will be made in your chest. The location of the incision varies depending on what type of procedure will be done:
- For a scalenectomy, an incision will be made just above your clavicle.
- For a rib resection, an incision will be made under your arm.
If you are having a scalenectomy, the scalene muscle will be cut and removed. If you are having a rib resection, the rib will be cut and removed.
Your incision will be closed with stitches (sutures), skin glue, or adhesive tape.
Your incision will be covered with bandages (dressings).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

You may continue to get fluids and medicines through an IV.
You will be given pain medicines to reduce any pain.
Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until you leave the hospital or clinic.
You may have to wear a sling to keep your arm from moving.
You may be shown exercises to help your arm heal. You may be referred to a physical therapist.

Summary

Thoracic outlet syndrome surgery consists of one or two procedures to treat thoracic outlet syndrome (TOS). The goal of this procedure is to reduce the compression that causes TOS.
Before the procedure, follow instructions from your health care provider about changing or stopping your medicines, and about eating or drinking restrictions.
After the procedure, you will be given pain medicines to reduce any pain.
You may be shown exercises to help your arm heal. You may be referred to a physical therapist.