Thoracic Outlet Decompression (TOD) is a surgical procedure aimed at alleviating symptoms associated with
Thoracic Outlet Syndrome (TOS), a condition where the blood vessels or nerves in the thoracic outlet (the space
between the collarbone (clavicle) and the first rib) are compressed. This compression can lead to pain in the
shoulders and neck, numbness in the fingers, and other symptoms.
TOS can be classified into three types: Neurogenic, Venous, and Arterial. Neurogenic TOS, the most common,
involves compression of the brachial plexus, a network of nerves. Venous TOS involves compression of the
subclavian vein, while Arterial TOS involves compression of the subclavian artery.
TOD is generally considered when conservative treatments, like physical therapy and medication, don’t provide
sufficient relief. The surgery aims to remove the source of compression. This might involve the removal of a cervical
rib (an extra rib extending from the neck) if it's present, or other structures like fibrous bands that contribute to the
compression.
The procedure can be performed through different surgical approaches depending on the cause and location of the
compression, surgical expertise and the specific needs of the patient. The most commonly employed approaches
are
1. Transaxillary approach (through the armpit).
2. Supraclavicular approach (above the clavicle).
3. Infraclavicular approach (below the clavicle).
Recovery from TOD varies. Some patients experience immediate relief, while others may have a longer recovery
period. Physical therapy is often recommended post-surgery to aid in recovery and ensure optimal outcomes.
While TOD can be highly effective for many patients, it is not without risks. Complications can include injury to the
nerves or blood vessels in the area, infection, and issues related to general anesthesia. Therefore, it’s essential for
patients to have a thorough discussion with their surgeon about the potential benefits and risks before proceeding
with the surgery.