The thoracic outlet is the space in the upper chest located between the collarbone and the first rib. This narrow space is crowded with muscles, blood vessels, and a bundle of nerves known as the Brachial plexus. Thoracic outlet syndrome occurs when the nerves and/or blood vessels within this space become compressed, resulting in a variety of vascular and/or neurologic symptoms depending on which structure is being compressed. Though many cases of thoracic outlet syndrome do not require surgery, careful evaluation and treatment by an experienced surgeon is crucial to relieving painful symptoms and to reducing the risk of more serious complications.
At West Coast Thoracic Surgery, renowned thoracic surgeons Ali Mahtabifard, MD and Clark Fuller, MD have undergone extensive training in the comprehensive management of thoracic outlet syndrome. After training at some of the country’s most prestigious medical institutions, Dr. Mahtabifard and Dr. Fuller now specialize in the use of video-assisted thoracic surgery (VATS) and other cutting-edge surgical techniques to deliver high quality, patient-centered care with excellent outcomes.
Causes of Thoracic Outlet Syndrome
Thoracic outlet syndrome may result from an injury, disease, or congenital problem such as an abnormally shaped or protruding first rib or an extra rib known as a cervical rib. A fairly common cause for the condition is weakened shoulder muscles in the chest, allowing the collarbone to slip down and compress the thoracic outlet. The condition is more common in women compared with men, who may have a smaller thoracic outlet more prone to compression. Symptoms are often aggravated by poor posture, obesity, or chronic weight-bearing on the shoulder (such as carrying a heavy bag).
Thoracic Outlet Syndrome Symptoms
Thoracic outlet syndrome can be difficult to diagnosis because it can cause a variety of vascular and neurologic symptoms that vary from person to person. While symptoms of nerve compression are the most common, an individual with thoracic outlet syndrome may experience:
- Aching pain in the neck, shoulder, arm, or hand
- Numbness and tingling in the forearm and the fourth and fifth fingers of the hand
- Swelling and redness in the arm
- Reduced blood flow into arm, making it feel fatigued
- Swelling or depression of the shoulder
- Overhead activities worsen symptoms
If you suffer from the above symptoms, our surgeons can perform a thorough diagnostic evaluation to determine if they are a result of thoracic outlet syndrome. A physical examination, imaging study (CT, MRI, ultrasound), and nerve conduction test may be performed to ensure an accurate diagnosis.
Treatment for Thoracic Outlet Syndrome
Treatment for thoracic outlet syndrome depends on the severity of symptoms and an individual’s response to conservative treatments. The following non-surgical therapies are usually attempted before surgery and may be effective at relieving symptoms for some patients:
- Physical therapy
- Weight loss
- Nonsteroidal anti-inflammatory medication
- Lifestyle changes
Minimally Invasive (VATS) First Rib Resection
When non-surgical treatments do not relieve symptoms of thoracic outlet syndrome, our surgeons can perform a well-established, highly effective procedure known as first rib resection. While many surgeons still use an open surgical approach, Dr. Mahtabifard and Dr. Fuller utilize the minimally invasive video-assisted thoracic surgery (VATS) technique to perform first rib resection.
The goal of thoracic outlet syndrome surgery is to relieve compression on the blood vessels and nerves (Brachial plexus) that run through the thoracic outlet by removing the entire first rib. Under general anesthesia, one 5 mm incision is made in the side of the chest. A small camera is then inserted through the incision, providing our surgeons with a live video feed throughout the entire procedure. After the first rib is located, it is cut from all its attachments and resected through an incision in the armpit. In addition, some of the muscles that contribute to the narrowness of the thoracic inlet, known as the scalene muscles, are removed as well. This decompresses the affected nerves or blood vessels and simultaneously increases the size of the thoracic outlet to help prevent future recurrence of symptoms.
Using VATS equipment, our surgeons can navigate the chest cavity with unparalleled precision and a greatly reduced risk of vascular or nerve damage. Additional benefits of minimally invasive first rib resection include reduced scarring, lower risk of post-operative complications, a faster recovery and improved surgical outcomes.
Contact a Los Angeles Thoracic Surgeon
West Coast Thoracic Surgery is a Beverly Hills-based center dedicated to the comprehensive treatment of thoracic conditions. Led by renowned thoracic surgeons Ali Mahtabifard, MD, and Clark Fuller, MD, we offer patients the most advanced medical knowledge and cutting-edge surgical techniques available to achieve exceptional results.
To learn more about thoracic outlet syndrome or to schedule your initial consultation with a Los Angeles thoracic surgeon, please contact 310.854.0909 or fill out our online contact form.
Click here to read Dr. Fuller’s interview with Bleacher Report discussing Thoracic Outlet Syndrome in professional athletes.
Next, read about hyperhidrosis (excessive sweating).