Thoracic outlet decompression (TOD) can treat thoracic outlet syndrome (TOS), where the nerves and blood vessels in your chest are compressed.

The aim of TOD is to reduce pressure on the structures inside the thoracic cavity. There are two types: first rib resection (FRR) and balloon angioplasty or venoplasty.

The type of surgery you need depends on what type of TOS you have and how severe it is.

Read on to learn more about how TOD surgery works and what to expect.

The goal of TOD surgery is to relieve pressure on the nerves and blood vessels in the thoracic cavity.

There are two main types of TOD surgery. The type your doctor recommends will depend on:

  • the type of TOS you have
  • the severity of the compression
  • the veins, arteries, or nerves it affects

First rib resection

FRR involves surgically removing the first rib. This is the rib at the very top of the ribcage, which often plays a role in TOS.

Sometimes, surgeons may also remove other tissues, such as scar tissue that may be compressing adjacent blood vessels, nerves, or muscles. They may also remove scalene muscles, which pass through the thoracic outlet.

A healthcare professional will give you a general anesthetic before the surgery.

To access the rib, a surgeon will make an incision above or below the collarbone. They will then remove the rib and use stitches to close up the incision.

Recovery may take several weeks. During this time, you’ll need to rest and restrict your usual activities.

Balloon angioplasty or venoplasty

Balloon angioplasty and balloon venoplasty aim to open the blood vessels in the arm and chest. Your healthcare professional might recommend this procedure after FRR.

A balloon angioplasty helps open up arteries, while a balloon venoplasty helps open up veins.

A healthcare professional will give you a local anesthetic before either of these procedures.

A surgeon will then insert a long, flexible device called a catheter into an artery or vein in the arm. They will guide the catheter to the narrowed section of the blood vessel and inflate the balloon to expand it.

The process takes 30–90 minutes.

Before either procedure, a nurse will prepare an intravenous (IV) line in your arm. This will allow you to receive fluids and medications. A healthcare professional will then give you the general anesthetic so that you’ll be asleep and unable to feel any pain during the procedure.

General anesthesia can cause short-term side effects like confusion and disorientation. It’s not safe to drive until these side effects have worn off, so you’ll need to arrange for someone to pick you up from the hospital.

In most cases, a healthcare professional will discharge you in 1–3 days.

Most people who have FRR can go home within a few days of the procedure. In the meantime, your care team will closely monitor your vital signs and give you pain medications if you need them.

You’ll likely feel soreness or discomfort, but you shouldn’t feel severe pain.

Your care team will likely encourage you to start moving around within a day or two of the surgery. This can help prevent surgical complications, such as blood clots.

After surgery, you should be able to return to many of your usual activities, but you should steer clear of vigorous exercise and heavy lifting.

Your healthcare professional will give you specific instructions on things to do and avoid to ensure the best recovery. They’ll also arrange a follow-up appointment to check on your healing.

There are three types of TOS.

Neurogenic TOS

Neurogenic TOS happens when the brachial plexus is compressed. The brachial plexus is a network of nerves that begins at the neck and crosses the chest to the armpit.

This is the most common type of TOS, accounting for 95% of cases.

The main symptom is Gilliatt-Sumner hand, in which the fleshy muscle at the base of the thumb wastes away and becomes very weak. Other potential symptoms include a dull, aching pain in the neck, shoulder, and armpit as well as numbness or tingling in the hand and fingers.

Venous TOS

Venous TOS happens when the subclavian vein, a major vein, is compressed. This large, deep vein drains the upper extremities.

Venous TOS is rare, accounting for only 4% of TOS cases.

Symptoms may include:

Arterial TOS

Arterial TOS involves the compression of a subclavian artery. These arteries sit just below the collarbone and supply blood to the upper extremities, neck, and head.

This is the rarest type of TOS, accounting for just 1% of cases.

It can cause the following symptoms in the hands and fingers:

  • poor circulation
  • changes in color
  • sensitivity to cold
  • numbness
  • tingling
  • swelling and heaviness

TOD is a type of surgery to treat TOS.

There are two main types of TOD: FRR and balloon angioplasty or venoplasty. FRR involves removing the first rib, which often plays a role in TOS. Balloon angioplasty and balloon venoplasty are procedures that help dilate compressed blood vessels.

Most people who get TOD can leave the hospital within 1–3 days of the procedure. You’ll likely be able to resume most of your day-to-day activities, but you shouldn’t perform strenuous exercise or heavy lifting until your body has fully healed.