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Thoracic Outlet Syndrome
Thoracic outlet syndrome (TOS) is caused by pressure in the neck on the nerves and/or blood vessels that go into the arm. You may have pain, numbness, tingling, swelling or weakness in your arm.
Surgery
You will be asleep under general anesthesia for the surgery to relieve the pressure in the neck. Our surgeon makes an incision in your chest and removes a part of your first rib. This helps relieve the pressure causing your symptoms. The surgeon will close the incision with stitches that will dissolve on their own. You will have a dressing over your closed incision.
Before Surgery
No eating or drinking for at least 12 hours before your surgery.
After Surgery
After surgery we will move you to your room. We closely watch your heart rate, blood pressure, and blood oxygen level.
When you wake up, you will have tubes and lines attached to you. You will have an IV in your arm for medicine and fluids. You may also have a chest tube that drains fluid from around your lungs. We will give you medicine for pain.
You may have blood tests, X-rays, ultrasounds, or other procedures. You may also need to wear compression stockings. These stockings help prevent blood clots in your legs. You cannot eat or drink for a few hours. You will start with clear liquids and eat more as you wake up. As you heal, you will work with nurses and occupational therapists (OT) to get back your strength in your arm.
Most patients who have this surgery can go home within 1 to 2 days.
Incision Care
You can shower but do not swim or take tub baths.
Clean the incision gently with mild soap and water. Remove any dried drainage.
Do not scrub the incision.
Rinse it and pat it dry.
Do not use any lotions, alcohol, powders, or oils on your incision, unless told by your doctor.
Leave the incision open to air unless told by your doctor.
The stitches will dissolve on their own. You may have small pieces of tape called Steri-Strips placed on the incision. After 2-3 days, the Steri-Strips will begin to curl up at the ends. With time, the strips will fall off on their own.
Activity
You should be able to do most of your basic daily routines at home. You may feel weak and tired. This is normal. Give yourself time for rest. Your strength and energy level will increase as your body heals. Your sleep pattern should return to normal. Walking is good for you and will help you get stronger. Start slowly. Increase your distance a little bit each day. Walking also helps prevent constipation and blood clots.
For the first few weeks, do not:
Lift more than 10 pounds. This includes groceries, pets, and children. One gallon of milk is about 8 pounds.
Vacuum or scrub floors.
Drive until your doctor says it is okay. This is often after the first clinic visit. Do not drive while taking opioid pain medicine.
Play contact sports.
Follow the exercises given to you by the OT. Try to increase the movement in your shoulder.
Ask your doctor at your follow-up visit when you may return to work and resume sex.
Pain
You will have some pain and/or prickly feelings in the back of the upper arm, abdomen, and at the incision. Your doctor may prescribe pain medicine for you to use at home. You should need less pain medicine as you heal. Talk to your doctor before you start any over-the-counter pain medicine.
The opioid pain medicine can make you constipated. Use over-the-counter stool softeners (senna/docusate) as needed to prevent constipation. Other ways to prevent constipation include drinking fluids and eating fiber. Vegetables and fruits (prunes, raisins, apples, oranges, potatoes, spinach, and carrots) and whole grain breads/rice have fiber.
Diet
You may not feel hungry after surgery. You should still try to eat. Eating well helps your body heal. It may be easier to eat small amounts of food throughout the day instead of eating three large meals.
Dehydration can cause you to feel tired and weak. Drink at least eight to ten 8 oz. glasses of fluid each day. Water and milk are good options. Drinks that contain caffeine (soda, coffee) are not the best choice for helping you to stay hydrated.
When to Call
Increased redness or warmth at the incision site.
Red streaks on your skin that extend from the incision site.
Bulging or swelling at the incision.
Foul-smelling or pus-like drainage (green or yellow) from the incision.
New bleeding from your incision.
Open spots on the incision where the skin is pulling apart.
Skin along the incision is getting darker or turning black.
Sudden increase in pain that is not controlled by your pain medicine.
Fever over 101.5 F (38.5C) by mouth for two readings taken 4 hours apart.
When to Go to the Emergency Room
Increased shortness of breath or trouble catching your breath.
Uncontrolled bleeding from the incision or anywhere else.
Follow Up
You will usually return to our clinic about 2 weeks after you go home.
Who to Call
Vascular Surgery Clinic
Monday-Friday, 8 am to 5 pm
(608) 263-8915
After hours, call hospital paging at
(608) 263-6400. Ask for the Vascular Surgery doctor on call. Give your name and phone number with the area code. The doctor will call you back.
The toll-free number is 1-800-323-8942