Surgery

If physical therapy and medication do not improve your symptoms, surgery may be an option. In appropriate cases, surgery can be helpful, but success rates vary. As with all surgical procedures, TOS surgery involves risks, especially risk of injury to the brachial plexus. Be sure you understand the surgical procedure involved, and discuss its potential risks and benefits with your health care provider.

Surgical options for TOS include:

• Decompression surgery – This involves removing the structures causing compression of or injury to nerves or blood vessels. For example, your surgeon may remove all or part of an extra rib (if you have one) or the first rib to open up space in the thoracic outlet. Or, the surgeon may remove some of the small muscles attached to the rib and other tissue that may put pressure on nearby nerves or blood vessels.

• Thrombolysis – If an arm vein is blocked by a blood clot, your surgeon may inject a clot-dissolving medication into the vein before or during decompression surgery. 

• Angioplasty – This procedure is used to unblock an artery. During angioplasty, your surgeon inserts a long, thin tube (catheter) through an artery in your arm and guides the catheter to the blocked artery. The surgeon opens the artery by inflating a tiny balloon attached to the end of the catheter. Sometimes, the surgeon also places a stent in the artery to help keep it open. 

• Other procedures – Sometimes, surgery is needed to repair a severely damaged blood vessel in the thoracic outlet. The damaged portion of the vessel may be replaced with a graft – either a vessel from another part of your body or a plastic artery or vein substitute. Or, your surgeon may use a blood vessel from another part of your body to reroute blood around the damaged area.