Thoracic Outlet Syndrome

Thoracic outlet syndrome (TOS) occurs when nerves or blood vessels are compressed in the space between the collarbone and first rib. Dr. Medani has specific expertise in TOS, with published research and fellowship training at the University of Toronto under world leaders in this field.

Symptoms to Watch For

  • Pain in the neck, shoulder, and arm
  • Numbness and tingling in the fingers (often the ring and little fingers)
  • Weakness in the hand or grip
  • Arm fatigue with overhead activities
  • Swelling, discolouration, or coldness in the arm or hand
  • Visible veins on the chest or shoulder (venous TOS)
  • Blood clots in the arm veins (Paget-Schroetter syndrome)
  • Symptoms often worsened by raising arms overhead or carrying heavy objects

How Dr. Medani Treats This

1

Conservative Management — Physiotherapy focusing on posture correction, shoulder girdle strengthening, and nerve gliding exercises. Many patients improve with dedicated physiotherapy.

2

First Rib Resection — Surgical removal of the first rib to decompress the thoracic outlet. This is the definitive treatment for patients who do not respond to conservative management. Dr. Medani has specific expertise in this procedure from his Toronto fellowship.

3

Scalenectomy — Removal or release of the scalene muscles that may be compressing the neurovascular structures. Often performed in combination with first rib resection.

4

Venous Thrombolysis — For venous TOS with blood clots (Paget-Schroetter syndrome), clot-dissolving treatment followed by surgical decompression.

5

Vascular Reconstruction — In rare cases of arterial TOS, surgical repair of the damaged artery may be necessary.

What to Expect

Diagnosis

TOS can be challenging to diagnose. Dr. Medani performs a thorough clinical examination with specific provocative tests, duplex ultrasound, and may order nerve conduction studies or MRI/CT angiography to confirm the diagnosis and identify the type of TOS.

Conservative Trial

For neurogenic TOS, a structured physiotherapy programme of 3-6 months is usually recommended first. Dr. Medani works with specialised physiotherapists experienced in TOS management.

Surgery

If conservative treatment fails, first rib resection is performed under general anaesthesia. The surgery takes 2-3 hours. Dr. Medani uses techniques refined during his fellowship at the University of Toronto.

Recovery

Hospital stay is typically 2-3 days. Most patients notice symptom improvement within weeks. Full recovery and return to normal activities takes 4-6 weeks. Physiotherapy continues after surgery.

Frequently Asked Questions

What is thoracic outlet syndrome?
Thoracic outlet syndrome (TOS) is a group of disorders that occur when blood vessels or nerves in the space between the collarbone and the first rib (the thoracic outlet) are compressed. There are three types: neurogenic (most common, affecting nerves), venous (affecting veins), and arterial (affecting arteries, the rarest).
Why is Dr. Medani particularly experienced with TOS?
Dr. Medani completed his advanced vascular surgery fellowship at the University of Toronto, which is internationally recognised as a centre of excellence for thoracic outlet syndrome. He trained under world leaders in TOS surgery and has published research on the topic.
How is TOS diagnosed?
Diagnosis requires a combination of clinical examination, patient history, and imaging. There is no single definitive test for neurogenic TOS, which is why expert clinical assessment is essential. Venous and arterial TOS can be confirmed with duplex ultrasound and CT/MR angiography.
Will I need surgery for TOS?
Not necessarily. Many patients with neurogenic TOS improve with dedicated physiotherapy. Surgery is recommended for patients who do not respond to at least 3 months of conservative treatment, or for patients with venous or arterial TOS who typically require earlier intervention.
What are the risks of first rib resection?
Like all surgery, there are risks including nerve injury, bleeding, pneumothorax (collapsed lung), and recurrence. Dr. Medani will discuss these risks in detail during your consultation. In experienced hands, complication rates are low and outcomes are generally excellent.

Book a Consultation for Thoracic Outlet Syndrome

Schedule a consultation with Dr. Medani to discuss your condition and learn about the treatment options available to you.

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