When do I need surgery?

Surgery is a last resort form of treatment.  10-20% of people with TOS need surgery.  Most people that need surgery have vein or artery compression.  Some people with neurogenic TOS need surgery.  Surgery can improve pain but may not help muscle weakness if TOS went untreated for a long time.  The goal of surgery is to create space and remove compression to the nerves, veins, and arteries.    

Surgery is commonly done by a neurologist, thoracic or vascular surgeon but can be done by a variety of doctors who have experience with TOS.  The most common methods for TOS surgery are entering your body through your armpit (transaxilliary approach) or just above your collarbone (anterior supraclavicular approach).  Removing muscles in your neck and chest may be needed to create even more space. 

The benefit of going through the armpit is you can remove the first rib without hurting the nerves or blood vessels.  The downside is limited access to the extra neck rib and fibrous bands because they are hidden behind nerves and blood vessels. 

Entering the body above the collarbone at the base of your neck is good for fixing compressed veins and arteries.  This approach lets the doctor look for signs of trauma or fibrous bands. 

Surgery has a lot of benefits but risks are possible.  Risks include nerve injury, bleeding, collapsed lung, difficulty breathing, and winging of shoulder blades. 

Recovery time differs from person to person, lasting 3 months to a year.  During this time, you will not be able to lift more than 10-15 pounds.  You should not use a purse, bookbag, or carry heavy things on your shoulder.  You will need to go to physical therapy to regain muscle strength, reduce pain and to prevent symptoms returning.