Treatment

In most cases, a conservative approach to treatment is effective, especially if your condition is diagnosed early. Treatment may include:

• Physical therapy. If you have neurogenic thoracic outlet syndrome, physical therapy is the first line of treatment. You'll learn how to do exercises that strengthen and stretch your shoulder muscles to open the thoracic outlet, improve your range of motion and improve your posture. These exercises, done over time, may take the pressure off your blood vessels and nerves in the thoracic outlet.
• Medications. Your doctor may prescribe anti-inflammatory medications, pain medications or muscle relaxants to decrease inflammation, reduce pain and encourage muscle relaxation.
• Clot-dissolving medications. If you have venous or arterial thoracic outlet syndrome and have blood clots, your doctor may administer clot-dissolving medications (thrombolytics) into your veins or arteries to dissolve blood clots. After you're given thrombolytics, your doctor may prescribe medications to prevent blood clots (anticoagulants).

Surgical options

Your doctor may recommend surgery if other treatment hasn't been effective, if you're experiencing ongoing symptoms or if you have progressive neurological problems.

A surgeon trained in chest (thoracic) surgery or blood vessel (vascular) surgery will perform the procedure.

Thoracic outlet syndrome surgery has risks of complications, such as injury to the brachial plexus. Also, surgery may not relieve your symptoms, and symptoms may recur.

Surgery to treat thoracic outlet syndrome, called thoracic outlet decompression, may be performed using several different approaches, including:

• Transaxillary approach. In this surgery, your surgeon makes an incision in your chest to access the first rib, divide the muscles in front of the rib and remove a portion of the first rib to relieve compression. This approach gives your surgeon easy access to the first rib without disturbing the nerves or blood vessels. But, that only gives your surgeon limited access and makes it harder to see muscles and cervical ribs that may be contributing to compression behind the nerves and blood vessels.

• Supraclavicular approach. This approach repairs compressed blood vessels. Your surgeon makes an incision just under your neck to expose your brachial plexus region.

  Your surgeon then looks for signs of trauma or muscles contributing to compression near your first (uppermost) rib. Your surgeon may remove the muscles causing the compression and repair compressed blood vessels. Your first rib may be removed if necessary to relieve compression.

• Infraclavicular approach. In this approach, your surgeon makes an incision under your collarbone and across your chest. This procedure may be used to treat compressed veins that require extensive repair.

In venous or arterial thoracic outlet syndrome, your surgeon may deliver medications to dissolve blood clots prior to thoracic outlet compression. Also, in some cases, your surgeon may conduct a procedure to remove a clot from the vein or artery or repair the vein or artery prior to thoracic outlet decompression.

If you have arterial thoracic outlet syndrome, your surgeon may need to replace the damaged artery with a section of an artery from another part of your body (graft) or an artificial graft. This procedure may be done at the same time as your procedure to have the first rib removed.