Name of the Procedure:

Excision of First and/or Cervical Rib

Summary

An excision of the first and/or cervical rib is a surgical procedure performed to remove an extra rib located above the first rib, known as a cervical rib, or to remove the first rib itself. This surgery is typically considered when these ribs cause nerve or blood vessel compression leading to symptoms.

Purpose

The procedure addresses thoracic outlet syndrome (TOS), a condition where the cervical or first rib compresses nerves or blood vessels, causing pain, numbness, or circulation problems. The goal is to alleviate these symptoms by removing the problematic rib.

Indications

• Persistent pain in the shoulder, neck, or arm.
• Numbness or tingling in the fingers.
• Weakness or atrophy of hand muscles.
• Swelling or discoloration of the arm.
• Diagnosed thoracic outlet syndrome that has not responded to conservative treatments.

Preparation

• Patients may be asked to fast for a certain period before the surgery.
• Preoperative imaging tests such as X-rays, MRIs, or CT scans to evaluate the rib and surrounding structures.
• Blood tests and a medical evaluation to ensure fitness for surgery.
• Adjustments to medications, especially blood thinners.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made near the base of the neck or in the armpit to give the surgeon access to the rib.
3. The surgeon carefully dissects the surrounding muscles and tissues to expose the rib.
4. The offending rib (cervical or first) is then carefully excised.
5. The incision is closed with sutures or staples, and a sterile dressing is applied.

Duration

The procedure generally takes about 1 to 3 hours, depending on complexity.

Setting

It is performed in a hospital or a specialized surgical center.

Personnel

• A surgeon specialized in thoracic or vascular surgery.
• An anesthesiologist to administer and manage anesthesia.
• Surgical nurses and possibly surgical technicians.

Risks and Complications

• Infection at the incision site.
• Bleeding or hematoma formation.
• Injury to nerves or blood vessels.
• Respiratory complications such as pneumothorax (collapsed lung).
• Persistent pain or recurrence of symptoms.

Benefits

• Relief from pain, numbness, and other symptoms of thoracic outlet syndrome.
• Improved quality of life and increased ability to perform daily activities.
• Benefits may be realized within weeks to a few months post-surgery.

Recovery

• Initial hospital stay of 1 to 3 days for monitoring.
• Pain management with prescribed medications.
• Instructions on wound care, activity restrictions, and physical therapy exercises.
• Full recovery and return to normal activities typically within 4 to 6 weeks.
• Follow-up appointments to monitor healing and progress.

Alternatives

• Physical therapy to strengthen muscles and improve posture.
• Medications such as anti-inflammatory drugs or muscle relaxants.
• Minimally invasive procedures like Botox injections for temporary relief.
• Pros and cons: Non-surgical options may not provide permanent relief but have fewer risks and shorter recovery times.

Patient Experience

• During the procedure, the patient will be under general anesthesia and not feel anything.
• Postoperatively, patients may experience pain at the incision site, managed with pain medication.
• Discomfort is expected but gradually subsides.
• Emotional support and clear communication with healthcare providers can aid in a smoother recovery.