What is Thoracic Outlet Syndrome Surgery

Thoracic outlet syndrome surgery consists of one or two procedures to treat thoracic outlet syndrome (TOS). TOS is a group of signs and symptoms that result when blood vessels or nerves that supply the arm and hand are squeezed (compressed).

The goal of this procedure is to reduce compression that causes TOS. During TOS surgery, you may have one or both of these procedures done:

• 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.
• 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.

What happens before the procedure?

• 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 before your procedure if your health care provider instructs you not to.
• Follow instructions from your health care provider about eating or drinking restrictions.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be given antibiotic medicine to help prevent infection.
• You may have a physical exam.
• You may have tests, including:
  • Blood tests.
  • Urine tests.
  • X-rays.
  • MRI.
  • CT scan.
  • Electrocardiogram (ECG).
  • Electromyogram (EMG).
• Plan to have someone take you home after the procedure.
• If you will be going home right after the procedure, plan to have someone with you for 24 hours.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins.
• You will be given a medicine to make you fall asleep (general anesthetic). You may also be given a medicine to help you relax (sedative).
• 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 stiches (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 receive fluids and medicines through an IV tube.
• You will have some pain. Pain medicines will be available to help you.
• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
• 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.
• Do not drive for 24 hours if you received a sedative.

Thoracic Outlet Syndrome Surgery, Care After

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain and stiffness in your chest, shoulder, and arm.
• A small amount of blood or clear fluid coming from your incision.

Follow these instructions at home:

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to be in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Driving

• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Do notdrive for 24 hours if you received a medicine to help you relax (sedative).

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not lift anything that is heavier than 10 lb (4.5 kg) until your health care provider approves.
• Do not take baths, swim, or use a hot tub until your health care provider approves.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have a fever.
• You have pain that gets worse or does not get better with medicine.
• You have more redness, swelling, or pain around your incision.
• You have more fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision.

Get help right away if:

• You have severe pain.
• You lose feeling in any part of your body, such as your fingers, hand, or arm.
• Your fingernails turn a dark color, such as blue or gray.
• Your hand or arm feels unusually cold.
• You have a tingling feeling in your hand or arm that does not go away.
• You cannot move your hand, arm, or shoulder.