Thoracic Outlet Syndrome is a condition where nerves and/or vascular structures are compressed in the shoulder region by the first rib, accessory (cervical rib) when present, muscles or abnormal fibrous bands resulting in various symptoms such as pain, numbness, weakness and swelling of the arm and hand. The most common variety is produced by compression of nerves (brachial plexus) as they cross over the first rib to enter the arm.
The majority of patients with this variety of Thoracic Outlet Syndrome are treated successfully with exercises and physical therapy alone.
Only 10-20% of these patients require surgical treatment to relieve the compression by removal of the first rib, abnormal muscles or fibrous band and/or accessory rib when present. Approximately 85-90% of patients requiring surgery obtain excellent relief of their symptoms.
The other, much more rare variety of Thoracic Outlet Syndrome is produced by compression of the vascular structures, such as the subclavian vein or the subclavian artery leading to the formation of blood clots. When the vein obstructs with blood clots, the symptoms are pain and swelling of the arm requiring emergency clot dissolving treatment and later operation to remove the first rib to relieve the compression. If the subclavian artery develops a clot, it is usually due to its compression by an extra rib (cervical rib), requiring an operation to remove it and sometimes replace the artery with a graft. Excellent results are obtained if the diagnosis and treatment are instituted early.
