Nerves and blood vessels pass through the space between the collarbone and first rib (the thoracic outlet) on their way from the chest cavity to the arm and hand. If the outlet is narrowed or inflamed by scar tissue from previous injury or from the presence of an extra rib or other abnormality, this compresses the nerves and vessels which may result in circulation issues and/or damage to the nerves. This can result in pain, weakness, numbness or tingling, and eventually more serious surgical problems.
Physical therapy is usually fairly effective at relieving these symptoms, but if it does not, decompression surgery may be able to fix the issue. This surgery involves removing the first rib and surrounding structures (such as scar tissue, extra (cervical) rib, and certain muscles) that were pressing in on the vessels and nerves. This is inpatient surgery done under general anesthesia. Typical hospitalization is two to three days, and requires physical therapy afterwards. A sling is typically not required and patients will have limited use of their arm and hand directly after surgery.