Thoracic outlet decompression surgery is a specialised procedure aimed at relieving the symptoms associated with
Thoracic Outlet Syndrome (TOS). TOS is a condition characterised by the compression of nerves, arteries, or veins
in the thoracic outlet, the space between the collarbone (clavicle) and the first rib. This compression can lead to pain,
numbness, and weakness in the neck, shoulder, and arm.
The surgery is typically considered when conservative treatments, such as physio therapy and medication, have
failed to alleviate symptoms. Thoracic outlet decompression surgery can significantly improve the symptoms of TOS,
especially in cases where conservative treatments have been unsuccessful. The main goal of the surgical
intervention is to remove the structures causing the compression. There are several approaches to thoracic outlet
decompression, each tailored to the specific type of TOS (neurogenic, venous, or arterial) and the patient's individual
anatomy.
Transaxillary Approach:This involves an incision in the armpit, through which a portion of the first rib is
removed, releasing the compression. This method is often used for neurogenic TOS, where the brachial
plexus nerves are compressed. Supraclavicular Approach:In this approach, an incision just above the collarbone to access and
remove the offending muscle, scar tissue, or extra rib causing the compression. This approach offers a
direct view of the nerve structures and is preferred in complex cases. Infraclavicular Approach:Although less commonly used, this approach involves an incision below the
collarbone, primarily used when vascular structures (arteries and veins) need repair. Pectoralis Minor Tenotomy:In some cases, the pectoralis minor muscle contributes to the compression
and may be surgically released.
Postoperatively, patients typically undergo a period of physical therapy to regain strength and flexibility. While the
surgery can be highly effective, it carries some risks. The decision to undergo thoracic outlet decompression is made
after a thorough evaluation by a specialist, considering the severity of symptoms and the impact on the patient's
quality of life.