Thoracic outlet decompression surgery

The cost of thoracic outlet decompression surgery with Circle Health Group depends on a variety of factors, including the type of surgery you have and where you have it. Your healthcare team will ensure you know the cost of your treatment at every stage of your journey with them, including information on how and when to pay it.

Fixed-price packages

Our fixed-price packages include the cost of your surgery and all appropriate aftercare appointments. However, any pre-surgery diagnostic tests and your consultant’s outpatient appointment consultation fee are charged separately.

Spread the cost of your payment

Our flexible payment options help you spread the cost of your payment across a time period that suits you. We offer fixed-term monthly payment plans over one to five years with no deposit required. If you decide to pay over 10 months, you will pay interest-free. If you are paying for a longer period, you will pay 14.9% APR.

Private health insurance

If you have private health insurance, your treatment will usually be covered by your provider. Speak to your insurer directly to find out more information on this.

If you have any questions about our fixed-price packages and flexible payment options, you can speak to a friendly member of our advisory team on 0141 300 5009.

Symptoms of thoracic outlet syndrome differ from person to person, and may not be present all of the time. If you have any of the below symptoms, it is possible that you might need thoracic outlet decompression surgery.

• Pain in your neck and shoulder that spreads into your arm (this can be constant or come and go)
• Temporary loss of feeling in your arm and/or fingers
• Temporary feeling of weakness or tingling in your arm and/or fingers
• Weakening grip
• Raynaud's phenomenon (a condition that restricts the blood supply to your fingers and toes, causing them to turn white)
• A blood clot in your subclavian artery (an artery that supplies blood to the upper limbs and parts of the head and neck)
• Swelling in your affected arm (this is rare)
• Fatigue in your arm following activity
• Throbbing lump near your collarbone
• Cold fingers, hands, or arms
• Weak pulse in your affected arm

These symptoms can be caused by a variety of conditions, which is why it's so important to speak to a specialist. They can identify the root of your problems and help you to choose the best treatments to address them.

Thoracic outlet decompression surgery is used when you have thoracic outlet syndrome - a condition caused by compressed nerves in the upper chest area. Your nerves travel through a space between your collarbone and first rib (the thoracic outlet), and when this outlet becomes either inflamed or narrowed, your nerves compress together, causing problems with circulation and/or damage to the nerves. This compression is what produces pain and numbness in your arm, neck, and hands.

There are three types of thoracic outlet syndrome that you might have. Symptoms vary depending on which condition you live with. In some cases, you might have a mixture of the three at one time.

Neurogenic thoracic outlet syndrome

The most common form of thoracic outlet syndrome. It happens when the network of nerves that control muscle movements and sensation in your shoulder, arm, and hand (known as the brachial plexus) become compressed.

Venous thoracic outlet syndrome

This occurs when one or more veins under the collarbone are compressed, leading to blood clots.

Arterial thoracic outlet syndrome

When one of the arteries under the collarbone is compressed, causing a bulging of the artery (also known as an aneurism), it is known as arterial thoracic outlet syndrome. This is the least common type of thoracic outlet syndrome.

Cervical rib

Another condition that can lead to thoracic outlet decompression surgery is a cervical rib. This is an extra rib - present from birth - that forms just above your first rib, growing out from the base of the neck above the collarbone. It is not normally a problem, but due to the way an extra rib creates increased pressure around the nerves in your thoracic outlet, it increases the chance of nerve compression and the development of thoracic outlet syndrome. Around one in 10 people with a cervical rib will have the condition at some point in their life.²

Since symptoms of thoracic outlet syndrome often vary from person to person, and tend to be quite vague, or similar to those of other conditions, making a diagnosis can be difficult. Your consultant will carry out a thorough examination to see if you have thoracic outlet syndrome and whether you need thoracic outlet decompression surgery.

Medical history

To start with, your consultant will ask about your symptoms, how long the issues have been present for, as well as your occupation and the physical activities you do. They will look at your medical history to rule out any other nerve-related conditions, including carpal tunnel and cervical spine disease, as they often have similar symptoms and can be mistaken for thoracic outlet syndrome.

Physical examination

After completing a medical history, your consultant will run you through a physical examination, which includes looking for any outward signs of thoracic outlet syndrome, such as depression in your shoulder, bony abnormalities above the collarbone, or swelling/pale discolouration in your arm.

They may then ask you to complete some physical manoeuvres that reproduce the symptoms of the condition. This would involve moving or lifting your arms, turning your head, or gripping something. Seeing how certain positions and movements lead to pain can help your consultant confirm if you have thoracic outlet syndrome.

Further tests

Your consultant may order further imaging and nerve study tests to make absolute sure that you have thoracic outlet syndrome. A number of tests can be used to make a diagnosis. These include but are not limited to:

X-ray

An X-ray may reveal an extra rib (a common cause of thoracic outlet syndrome), along with potentially ruling out other bone or muscle issues that may be causing your symptoms.

CT scan

By picking up cross-sectional images of your body, a CT scan can identify the location and cause of any nerve compression in your upper chest area.

MRI scanning

MRIs allow your consultant to see the location and cause of nerve compression, as well as any abnormalities in your upper chest area that may be the reason behind your thoracic outlet syndrome.

After this three-step process is complete (medical history, physical examination, imaging tests), your consultant will be able to tell if the pain in your arm, shoulder, and/or hands is a consequence of having compressed nerves in your thoracic outlet. If they determine that you do have thoracic outlet syndrome, they will most likely start off by prescribing a physiotherapy routine. You'll be given exercises that encourage the stretching and strengthening of shoulder muscles, which in turn open up the thoracic outlet and improve range of motion/posture.

These exercises, combined with anti-inflammatory medication and/or pain relief, may take the pressure off the nerves in your thoracic outlet and relieve your symptoms. If these steps don't work, however, your consultant may suggest that you have thoracic outlet decompression surgery.

Prepare for a hospital stay

After thoracic outlet decompression surgery, you will need to remain in hospital for two or three days as we monitor your response to treatment and provide you with pain relief if needed. So, be sure to bring anything that would support you during your stay, such as comfy loose-fitting clothing.

Medication

Please speak to your consultant about what medications you are taking ahead of thoracic outlet decompression surgery. If you are taking aspirin, anti-inflammatory medications, or any other 'blood thinning' medications, you will be advised to stop taking them one week before your surgery date to ensure against any unwanted bleeding during and/or after the procedure.

Eating and drinking

Make sure you eat a healthy balanced diet ahead of your operation, along with avoiding any alcohol 48 hours prior to your visit to hospital. As is generally the case before surgery, don't eat or drink anything past midnight on the day of your thoracic outlet decompression surgery.

Stock up on supplies

After you get home from hospital, you will need to rest. Your energy levels will be low, so taking quick trips to the shop won't be possible for a week or so as you recover. To prepare for this, make sure you have stocked up on everything you need ahead of the procedure. If you need something additional during your rest period at home after surgery, see if a family member or friend can grab it for you.

Stop smoking

Smoking in the leadup to surgery increases the chances of breathing and/or heart problems after surgery, along with meaning you require more general anaesthetic. It also poses a risk to your overall recovery. We therefore always recommend that you stop smoking at least two weeks before your thoracic outlet decompression surgery. If you need help with this, please speak to your consultant.

Given the various types of thoracic outlet syndrome, thoracic outlet decompression surgery may be performed using different approaches. All of these operations typically take around 2 hours, and are performed under general anaesthesia, meaning you'll be asleep for the entire time and feel no pain. Your surgeon may insert a breathing tube down your throat into your lungs to support your breathing during the operation.

There are three main forms of thoracic outlet decompression surgery: rib resection, balloon angioplasty and venoplasty, and scalenectomy.

Rib resection

Your surgeon will make a small incision under your arm or above the collar bone. A small part of your first rib and surrounding tissues will then be removed, which in turn relieves the pressure on your nerves, thereby removing the source of your pain.

If required, your surgeon will also repair any damage to blood vessels that has occurred due to this compression. The incision is then closed with stitches and covered with a dressing.

Balloon angioplasty and venoplasty

Often delivered after a rib resection, this treatment opens narrowed arteries in the arm and chest - something that occurs in people with venous thoracic outlet syndrome (when one or more veins under the collarbone are compressed).

Your surgeon will make an entrance into the arm with a needle, ahead of inserting a catheter (a thin, flexible tube that can be safely placed into your skin) with an inflatable balloon at the tip into an artery or vein, ahead of guiding the catheter into the space between your first rib and collarbone that has become narrowed or inflamed. They can then increase space in the affected area.

Scalenectomy

This procedure involves your surgeon making a small incision above your collarbone, creating a path to the scalene muscles - the muscles that pass through the space between your first rib and collarbone. Using a special device, they will remove the scalene muscles that are causing compression of the nerves and blood vessels. This may be performed alongside surgery to remove an extra rib.

Recovering in hospital

You might feel a bit disoriented when you first wake up from surgery, but this is natural as the general anaesthetic wears off. We will transfer you to a hospital bed and keep an eye on your vital signs, such as heart rate and breathing. You will probably have a tube draining fluid from your chest, which will be removed on the morning after the surgery. A sling for your arm is normally not required; you should be able to make gentle movements with your arms and hands after the procedure.

If you are in any discomfort at all, we will make sure you are provided with all the pain relief you need. We will encourage you to walk gently on the second day, ahead of discharging you either later that day or three days after your thoracic outlet decompression surgery.

Three to seven days after surgery

After getting home from hospital, you will need to take it easy. Be sure to get plenty of rest while also doing deep breathing and coughing exercises every one or two hours, as prescribed by your consultant. You will be able to take a shower on day three. Our team will give you detailed advice on how to look after dressings, manage your pain, and which exercises to do.

One to two weeks after surgery

After seven days, you can start to go through some gentle exercises, such as passive and active stretching, as these help to reactivate your muscles. It could be that your physiotherapist recommends hands-on treatment like massage, which can help to relieve pain and speed up the healing process. You will also be given advice and support around pain management and exercise load during this time.

Two to six weeks after surgery

After two weeks, you should be able to drive again. A return to work usually comes at this stage as well, provided you have a desk job. If your work involves heavy lifting or other forms of strenuous activity, speak to your consultant about when you can go back. You will also be encouraged to step up your physiotherapy programme. This might include:

• Taking regular walks
• Pain-free mobility exercises
• Stretching
• Joint mobilisation
• Working on a stationary bicycle
• Hydrotherapy (exercises in the water)

From six weeks onwards, physiotherapy will continue to intensify in accordance with how you are progressing. Every individual recovery timeline is different, so you might be back to 100% sooner than these averages, or the process might take a little longer. Your physiotherapist will modify your recovery plan to suit you.

Like with any surgery, complications can sometimes occur, but these are extremely rare. Your consultant will explain all the risks to you beforehand, along with answering any questions you might have, so you'll be able to make an informed decision about how to go forward.

General complications of any operation

• Pain
• Bleeding
• Infection of the surgical incision
• Unsightly scarring
• Blood clots
• Difficulty passing urine
• Chest infection
• Heart attack or stroke

Specific complications of thoracic outlet decompression surgery

• Nerve or tissue damage
• Recurrence of symptoms
• Brachial plexus (injury to nerves that send signals from spinal cord to you shoulder, arm, and hand)
• Phrenic nerve (injury to nerve that supports your diaphragm)
• Paralysis
• Vein injuries
• Axillary artery thrombosis (compression of a blood vessel in your upper arm, causing blood clots to develop)
• Hemothorax (collection of blood in the space between the chest wall and lung)
• Pneumothorax (collapsed lung)
• Chylothorax (fluid containing white blood cells accumulates in your chest cavity)
• Weakness of the hand muscles
• Sensory deficits
• Autonomic dysfunction (damage to autonomic nervous system)
• Death

When you choose to go private with Circle Health Group, you can expect:

• Flexible appointment times and locations to suit your schedule
• The freedom to choose which hospital and consultant suit your needs
• Person-centred, consultant-led treatment plans adapted to you
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standards and delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to learn more about thoracic outlet decompression surgery, book your appointment online today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in November 2022. Next review due November 2025.

1. Decompression surgery for thoracic outlet syndrome, Temple Health
2. Cervical rib, NHS
3. Thoracic outlet syndrome, John Hopkins Medicine
4. Surgery for thoracic outlet syndrome, NYU Langone Health
5. Decompression, physio.co.uk
6. Evaluation of Complications after Surgical Treatment of Thoracic Outlet Syndrome, NCBI