In this Guide

If you've been scheduled for a First Rib Resection surgery, you probably have some questions. Our guide offers the answers you're looking for, and helps you prepare for your operation.

About the Operation

The First Rib Resection is a decompression surgery for Thoracic Outlet Syndrome. The surgery is to help relieve pain felt in the arm or hand, or to reduce the risk of having a further upper arm venous clot.

Pressure on the blood vessels or nerves that supply blood to your arm and hand can cause blood flow issues or nerve damage. To relieve the pain, your surgeon will remove the first rib, certain muscles or surrounding tendons and fibrous bands that were pressing on the vessels and nerves.

Why do I need this surgery?

Blood vessels (arteries and veins) and nerves pass through the space between the collarbone and the armpit (called the thoracic outlet) on their way from the front of the shoulders and chest to the arm and hand.

Diagram of thoracic outlet areaThe drawing to the right shows the thoracic outlet area (the space between the collarbone and armpit).

You have Thoracic Outlet Syndrome (also called "TOS"), where there is compression causing injury or irritation to the nerves and blood vessels causing pain, swelling, weakness, numbness or tingling.

There is often no direct cause for developing TOS, but it may be related to:

  • Trauma or injury
  • Weight lifting
  • Having a cervical rib (you are born with an extra rib extending from the neck)
  • Weight gain
  • Growth of a tumour
  • Neck and arm positions used at work and home
  • Poor posture

The decompression surgery will try to take away the pressure on the nerves and blood vessels so you can go back to your usual activities.

How does my doctor know that I have TOS?

TOS can be difficult to diagnose. To assist with their diagnosis, your surgeon will:

  • Do a full medical history and physical examination
  • Look for pain, numbness, tingling or weakness in your arm
  • Conduct tests, which may include X-ray imaging, magnetic resonance imaging (MRI), electromyography (EMG) or nerve conduction studies and contrast venography
Download a printable version of the full First Rib Resection Surgery for Thoracic Outlet Syndrome guide:
First Rib Resection Surgery for Thoracic Outlet Syndrome​​​