First Rib Resection
For Thoracic Outlet Syndrome (TOS)
Thoracic Outlet Syndrome
Thoracic Outlet Syndrome (TOS) is caused
by pressure in the neck on the nerves and/or
blood vessels that go into the arm. You may
have pain, numbness, tingling, or weakness
in your arm.
The surgery to relieve the pressure in the
neck is done under general anesthesia. This
means you are asleep during surgery. Our
surgeon makes an incision in your chest.
Then the surgeon removes a part of your
first rib. This helps relieve the pressure
causing your symptoms. The incision is
closed with stitches that do not need to be
removed. A dressing is put over your closed
What to expect before surgery
You are not able to eat or drink anything for
at least 12 hours before your surgery.
What to expect after surgery
After surgery you are moved to a hospital
room. We closely watch your heart rate,
blood pressure, and blood oxygen level.
When you wake up you will have tubes and
lines attached to you. You will have an
intravenous line (IV) in your arm for
medicine and fluids. You may also have a
chest tube. This is a tube that goes from
your chest to a collection canister to drain
any fluid from around your lungs. You are
given medicine to help your pain.
You may have blood tests, X-rays,
ultrasounds, or other procedures. You may
also need to wear compression stockings.
These stockings help prevent blood clots in
your legs. You are not able to eat or drink
for a few hours. You will start with drinking
clear liquids and are able to eat more as you
wake up. As you recover, you work with
nurses and occupational therapists (OT) to
get back your strength in your arm.
Most patients who have this surgery can go
home within 1 to 2 days.
Care of the incision
Your incision is most often closed with
stitches. A few things to know:
ξ You may get the incision wet in the
shower. Do not swim or take tub
ξ Clean the incision gently with mild
soap and water. Remove any dried
ξ Do not scrub the incision.
ξ Rinse it and pat it dry.
ξ Do not use any lotions, alcohol,
powders, or oils on your incision,
unless told by your doctor.
ξ Leave the incision open to air unless
told by your doctor.
The stitches in your incision do not need to
be removed. There may be small pieces of
tape called Steri-Strips® placed on the
incision to help support it. You may shower
with the Steri-Strips® in place. Allow the
water to flow gently over the area. Do not
rub the incision. Do not swim or take tub
baths. Gently pat the incision dry. After 2-3
days, the Steri-Strips® will begin to curl up
at the ends. With time the strips will fall off
on their own.
When you go home you should be able to do
most of your basic daily routines. You need
to give yourself time for rest. You may feel
weaker. You may notice that you become
tired more easily than before. This is
normal. Your sleep pattern should return to
normal. Your strength and energy level will
increase as your body recovers. Walking is
good for you. It is important that you start
slowly. You should increase your distance a
little bit each day. This will help you
become stronger. Walking also helps
prevent constipation and blood clots.
There are some things that you should not
do in the first few weeks. These include:
Do not lift more than 10 pounds
during the first 2 weeks at home.
This includes groceries, pets, and
children. One gallon of milk is about
No vacuuming or scrubbing floors.
Do not drive until your doctor says it
is okay. This is often not until after
the first clinic visit. Do not drive
while taking narcotic pain medicine.
Do not play contact sports.
Follow the exercises given to you by
the OT. Work on increasing the
movement in your shoulder.
Ask your doctor at your follow-up
visit when you may return to work
and resume sexual activity.
It is normal to have some pain and/or prickly
sensations in the back of the upper arm, your
abdomen, and at the incision. Your doctor
may have prescribed pain medicine for you
to use at home. This is often the same
medicine you have been taking in the
hospital. The pain will decrease as the
incision heals. You should then need less
pain medicine. At that time you can use an
over-the-counter pain medicine. Talk to
your doctor before starting any over-the-
counter pain medicine. Do not drive when
taking narcotic pain medicine.
The narcotic pain medicine can make you
constipated. It is important to prevent
constipation. You can use over-the-counter
stool softeners (Senna/Docusate) as needed.
Other ways to prevent constipation include
drinking fluids and eating fiber. Vegetables
and fruits (prunes, raisins, apples, oranges,
potatoes, spinach, and carrots) and whole
grain breads/rice have fiber. Staying active
also helps prevent constipation.
It is common after surgery to have less of an
appetite. Even if your appetite is poor, try to
eat. Eating well helps your body heal. It
may be easier to eat small amounts of food
many times a day instead of eating three
large meals. It is also important to drink
enough fluid to stay hydrated. If you are
dehydrated you can become tired and weak
more easily. Drink at least eight to ten 8 oz.
glasses of fluid each day. Water and milk
are good options. Drinks that contain
caffeine (soda, coffee) can dehydrate your
body so they are not the best choice for
helping you to stay hydrated.
When to call the doctor
An increase in redness or warmth at
the site of the incision.
Red streaks on your skin that extend
from the site of the incision.
Bulging or swelling at the incision.
Foul-smelling or pus-like drainage
(green or yellow) from the incision
New bleeding from your incision
Open spots on the incision where the
skin is pulling apart.
If you notice the skin along the
incision is getting darker or turning
Sudden increase in pain that is not
controlled by your pain medicine.
A temperature of more than 101.5° F
(38.5°C) by mouth for two readings
taken 4 hours apart.
If you notice these symptoms go to the nearest emergency room.
Increased shortness of breath or trouble catching your breath.
Uncontrollable bleeding from the incision or anywhere else.
When to Follow up
You will usually return to the Vascular Surgery Clinic about 2 weeks after you go home.
What number to call the doctor at
Vascular Surgery Clinic at (608) 263-8915 from 8:00 am to 5:00 pm Monday through Friday.
After hours, call hospital paging at (608) 263-6400. Ask for the Vascular Surgery doctor on-call.
Give paging your name and phone number with the area code. The doctor will call you back.
If you live out of the area, call 1-800-323-8942.
Fahey, Victora A. 4th Ed. Vascular Nursing. Philadelphia: WB Saunders Co., 2004.
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 3/2017. University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5354