Outcomes 2016 - Baylor Hamilton Heart and Vascular Hospital FY 2016 | Page 52

Thor acic Outlet Syndrome: First Rib Resection
Baylor Jack and Jane Hamilton Heart and Vascular Hospital is one of the nation’s leading treatment centers for
thoracic outlet syndrome (TOS) – a condition where the nerve, artery, and vein between the lower neck and upper
chest become compressed, causing pain, numbness, and weakness in the upper extremity. This space is called the
thoracic outlet.
Patients who suffer daily disabling symptoms secondary to
TOS are offered relief with “First Rib Resection,” a treatment
offered as a part of the vascular program at Baylor Hamilton
Heart and Vascular Hospital. TOS occurs due to compression,
injury, or irritation of the nerves and blood vessels in the
thoracic outlet, located in the lower neck and upper chest area.
TOS can severely inhibit the quality of life, often leading to
pain, numbness, tingling and weakness in the arm, and pain in
the chest and neck resulting from neurovascular compression.
Reasons for the narrowing of this thoracic space vary. A
patient born with an extra rib or a very narrow space may
experience symptoms of TOS. Overuse of the shoulders and
arms may also lead to symptoms including poor posture.
Whiplash injury to the back or neck, sleep disorders, even
stress or depression can increase the risk of developing TOS.
Some types of this condition are more severe, resulting in
aneurysms and blood clots.
Although TOS affects men and women of all ages, it is more
common among young, competitive athletes who participate
in activities that require repetitive motions of the arm and
shoulder such as is required in baseball, swimming, volleyball,
tennis, and other sports.
Types of TOS disorders and related symptoms treated by
vascular surgeons on the medical staff at Baylor Hamilton
Heart and Vascular Hospital include neurogenic thoracic
outlet syndrome, venous thoracic outlet syndrome, and arterial
thoracic outlet syndrome. Diagnostic tests for thoracic outlet
syndrome include nerve conduction studies, vascular studies,
chest X-rays, cervical spine X-rays, CT and MRI of the chest
or spine, arteriograms/venograms, and blood tests.
The First Rib Resection procedure involves removing the
first rib and attached muscle, eliminating the pressure on the
thoracic outlet. In some cases, blood vessels around the area
will need to be rerouted; if the vessels are extremely narrowed,
angioplasty may become an option. Vascular surgeons on the
medical staff at Baylor Hamilton Heart and Vascular Hospital
nationally perform the largest volume of TOS procedures
annually, treating patients from across Texas and referred from
across the U.S.
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Courtesy of Cleveland Clinic Center for Medical Art and Photography
For high performance young athletes,
TOS is often a result of overtraining
or overuse. Repetitive overhead arm
movement can lead to an overstretch
injury to the muscle, or cause the
development of scar tissue that may
compress the neurovascular bu ndle
that leads into the arm from the neck and chest.
First rib resection frequently results in a successful
return to full activity.
Gregory Pearl, MD, FACS*
Medical Director, Vascular Surgery –
Baylor Hamilton Heart and Vascular Hospital
Co-Chair, Vascular Surgery Section –
Baylor University Medical Center at Dallas
*Dr. Pearl performed more TOS procedures than any other vascular surgeon in the U.S. (2015)
TOTAL NUMBER OF TOS SURGERIES (FY16):
145