Thoracic outlet Syndrome due to a cervical rib: treatment options

Patient

Q: I'm a 14 year old girl and I've been diagnosed with thoracic outlet syndrome caused by a cervical rib. It causes me a reasonable amount of pain and discomfort. I would like to know: will I need surgery to fix this?

Doctor

A:    Thoracic outlet syndrome is a group of disorders that occur when the blood vessels or nerves in the thoracic outlet — the space between your collarbone and your first rib — become compressed. This can cause pain in your shoulders and neck and numbness in your fingers. Treatment for thoracic outlet syndrome usually involves physical therapy and pain relief measures. Most people improve with these conservative approaches. In some cases, however, your doctor may recommend surgery. If conservative treatments don't improve your symptoms or if you're experiencing signs of significant nerve damage, worsening muscle weakness or incapacitating pain, your doctor may recommend surgery. Your doctor also may recommend surgery if you've been diagnosed with true neurogenic thoracic outlet syndrome, for which surgery is often the only treatment option, and for certain blood vessel complications, such as obstructed blood flow (occlusion) or ballooning of a portion of an artery (aneurysm) due to weakness in the wall of the blood vessel. Surgery is usually effective in relieving pain associated with thoracic outlet syndrome. It may not be as successful in treating muscle weakness, especially if the condition has gone untreated for an extended period. A specialist in thoracic surgery or vascular surgery will perform the procedure. Thoracic outlet syndrome left untreated can cause permanent nerve damage; however, surgery to treat thoracic outlet syndrome is considered risky. This is because the procedure involves dividing a muscle in the neck and removing a portion of the first rib or repairing the brachial plexus nerves. For this reason, most doctors initially recommend a conservative treatment approach. If you're diagnosed with thoracic outlet syndrome, your doctor or physical therapist will instruct you on exercises to do at home to strengthen and support the muscles surrounding your thoracic outlet. In general, to avoid unnecessary stress on your shoulders and muscles surrounding the thoracic outlet:  Keep good posture at all times, take frequent breaks at work and also try to practice relaxation techniques.

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