First Rib Resection + Anterior/Middle Scalenectomy (Open/Axillary/Supraclavicular/Thoracoscopic)

Decompression may be considered after specialist assessment when Thoracic Outlet Syndrome (TOS) is suspected or diagnosed and significant pain, numbness, weakness, or evidence of venous/arterial compression persists despite standard physical therapy and lifestyle adjustments. The decision is usually based on the type (neurogenic, venous, arterial), imaging and electrophysiological results, previous treatment response, presence of thrombosis or blood flow restriction, and overall health and anesthesia tolerance.