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Thoracic Outlet Decompression - first-rib resection, done by teams who do it often.

Surgical decompression of the thoracic outlet - first-rib resection with scalenectomy, plus vein or artery reconstruction where needed. A consultant vascular or thoracic surgeon on a documented TOS list, MDT with vascular medicine and physiotherapy, and honest expectations set out before consent.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private thoracic outlet decompression costs in the UK.

Indicative ranges across our partner vascular and thoracic centres.

In short

£13,000–£22,000, home 2–4 nights.

Procedure Indicative range
Supraclavicular first-rib resection + scalenectomy £13,000–£17,000
Transaxillary first-rib resection £13,000–£17,000
First-rib resection + venous reconstruction (Paget-Schroetter) £18,000–£22,000
First-rib resection + arterial reconstruction / bypass £20,000–£26,000
Cervical rib excision £11,000–£15,000
Duplex with positional testing + CT/MR angiography £700–£1,400
Vascular surgical consultation only £250–£450

Prices vary by TOS subtype - neurogenic sits at the lower end, venous with reconstruction in the middle, arterial with bypass at the top. Additional imaging and pre-operative venous thrombolysis add to the total.

The problem

The right subtype, the right approach, the right team.

Thoracic outlet syndrome is often over-diagnosed and under-treated in equal measure. We insist on subtype clarity - neurogenic, venous or arterial - before any operation is discussed.

  • What subtype is it, really?

    Neurogenic, venous (Paget-Schroetter) and arterial TOS are three different diseases with three different pathways.

  • A dedicated TOS list

    Outcomes correlate with volume. We only introduce you to surgeons who run a documented TOS list, not one-off operators.

  • Physiotherapy has been given a fair go

    For neurogenic TOS, 3–6 months of specialist physiotherapy is expected before surgery is offered.

When it helps

When thoracic outlet decompression is the right step.

The situations we see most, plus the red flag that means emergency vascular admission, not a routine booking.

  • Neurogenic TOS with clear provocation signs

    Arm and hand symptoms brought on by overhead activity, with positive provocation tests and matching neurophysiology.

  • Failed structured physiotherapy for neurogenic TOS

    3–6 months of specialist TOS physiotherapy without meaningful benefit, in the correct clinical picture.

  • Paget-Schroetter (venous TOS)

    Effort thrombosis of the subclavian vein - often in throwers, swimmers or gym athletes. Time-sensitive.

  • Arterial TOS with aneurysm or embolism

    A subclavian artery aneurysm or embolic events - an urgent vascular indication.

  • Cervical rib or fibrous band

    A cervical rib or congenital band identified on imaging causing recurrent symptoms.

  • Overhead athlete with symptomatic compression

    Throwers, swimmers, weightlifters or violinists with symptoms specifically limiting sport.

  • Symptomatic after clavicle fracture

    A malunited clavicle causing thoracic outlet compression - a considered indication after imaging.

  • Red flag: sudden cold, white arm

    A sudden pale, cold, painful arm suggests arterial embolism or acute thrombosis - same-day vascular admission, not an outpatient booking.

Procedure options

The approach follows the subtype.

What each option involves - supraclavicular, transaxillary, infraclavicular - and where venous or arterial reconstruction fits.

  • Supraclavicular approach

    Access from above the collarbone. Best exposure of the brachial plexus and scalenes; the workhorse for neurogenic TOS.

  • Transaxillary approach

    Access from the armpit. Best cosmetic result and good for first-rib resection with minimal plexus manipulation.

  • Infraclavicular approach

    Access below the collarbone - useful adjunct for venous or arterial reconstruction alongside another approach.

  • Combined supra- and infraclavicular

    Used for complex venous or arterial reconstruction to give full corridor access.

  • Cervical rib excision

    Where a cervical rib or fibrous band is present, this is added to the standard first-rib resection.

  • Venous thrombolysis + surgery

    For Paget-Schroetter, catheter-directed thrombolysis is done acutely, then surgery within days to weeks depending on the vein.

  • Arterial bypass or patch

    For arterial TOS with aneurysm or occlusion, decompression is combined with subclavian artery patch, resection or bypass.

  • Structured TOS physiotherapy alone

    For milder neurogenic TOS, a considered physiotherapy programme with a TOS-experienced physiotherapist is a valid endpoint in its own right.

Safety and recovery

What to expect afterwards - honestly.

Thoracic outlet decompression is a specialist operation. The things worth planning are the subtype diagnosis, the specific approach, and - for venous and arterial TOS - the reconstruction and anticoagulation plan.

  • GA in a proper theatre, with a vascular-anaesthetist

    Every decompression is under GA with an anaesthetist familiar with lung isolation where the pleura is entered.

  • Brachial plexus injury

    The plexus runs through the operative field. Transient sensory changes are common; permanent motor injury is rare, reported under 1 percent in high-volume series.

  • Vascular injury and reconstruction

    Subclavian vein or artery injury is uncommon but managed on the table with repair or bypass by the same team.

  • Pneumothorax and chest drain

    The pleura is often entered - a small pneumothorax is common and a short-term chest drain manages it.

  • Bleeding and haematoma

    Bleeding is uncommon; anticoagulants are paused as directed and restarted early for venous TOS.

  • Wound and infection

    Wound infection under 2 percent. Careful dissection and layered closure keep the neck scar (supraclavicular) or axillary scar cosmetically acceptable.

  • Anticoagulation after venous TOS

    Following surgery for Paget-Schroetter, a period of anticoagulation is standard, with follow-up duplex to confirm patency.

  • Persistent symptoms and revision

    A proportion of neurogenic TOS patients have residual symptoms even after successful surgery. Structured post-op physiotherapy matters and is planned from day one.

  • Red flags after surgery

    Sudden shortness of breath, cold pale arm, uncontrolled pain, fever or spreading redness needs the same-day team or A&E - not a routine call.

Reading your operation note

Your operation note in four parts. Read the last one first.

Whichever approach was used, the note the vascular or thoracic surgeon sends you keeps to the same shape.

A UK vascular surgeon reviewing a patient’s thoracic outlet decompression operation notes

A quiet reminder

Surgical language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the operation note and the rehab plan before your review, just ask.

  1. 01 Header

    Indication, subtype and approach

    Why the operation was done - neurogenic, venous or arterial - and which approach was used.

  2. 02 Technique

    Rib resection, scalenectomy and reconstruction

    Extent of first-rib resection, scalenectomy, cervical rib excision and any venous or arterial reconstruction.

  3. 03 Findings

    Plexus, vein and artery condition

    What was seen - plexus adhesions, venous stenosis, arterial aneurysm - and any decisions taken on the table.

  4. 04 Impression

    Anticoagulation, rehab and follow-up

    Read this first: anticoagulation duration, physiotherapy plan and the duplex, 6-week, 3-month and 12-month reviews.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Thoracic outlet decompression is usually covered when medically indicated. Neurogenic TOS often needs a documented physiotherapy trial for cover; venous and arterial TOS are covered as an urgent vascular indication.

Frequently asked

Everything we get asked about thoracic outlet surgery.

Quick answers on subtypes, approaches, expected benefit, cost and recovery.

  • What is thoracic outlet syndrome?

    A group of three conditions in which nerves, veins or arteries running between the collarbone and first rib are compressed. Neurogenic TOS is by far the most common and gives arm and hand symptoms. Venous TOS (Paget-Schroetter) causes arm swelling and clot. Arterial TOS is rare and can present with a cold arm, embolic events or an aneurysm.

  • Do I need surgery for neurogenic TOS?

    Not always. Most neurogenic TOS is managed with a structured 3–6 month programme with a TOS-experienced physiotherapist, activity modification and - for some patients - a diagnostic scalene block. Surgery is offered when a well-selected clinical picture fails to respond to a proper physiotherapy trial.

  • What is Paget-Schroetter and how is it treated?

    Effort thrombosis of the subclavian vein - usually in a young thrower, swimmer, or overhead athlete. Treatment is time-sensitive: catheter-directed thrombolysis to clear the clot, then first-rib resection with vein reconstruction within days to a few weeks, followed by a period of anticoagulation.

  • How much does private thoracic outlet decompression cost in the UK?

    Roughly £13,000–£17,000 for a supraclavicular or transaxillary first-rib resection, £18,000–£22,000 with venous reconstruction (Paget-Schroetter), £20,000–£26,000 with arterial bypass, and £11,000–£15,000 for cervical rib excision.

  • How long is recovery?

    Most people are back to desk work in 4–6 weeks after neurogenic TOS surgery and 6–8 weeks after venous or arterial reconstruction. Return to overhead sport is a graded 3–6 month rehab, guided by a TOS physiotherapist. Driving when you can perform an emergency stop without pain - usually 3–4 weeks.

  • Which approach is better - supraclavicular or transaxillary?

    Both are valid, and choice depends on the subtype, the surgeon’s training and - for neurogenic TOS - the extent of plexus dissection needed. Transaxillary gives a cosmetically hidden scar and good first-rib access. Supraclavicular gives the best plexus exposure. Combined approaches are used for complex reconstructions.

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