Frequently Asked Questions

St.Vincent Center of Thoracic Outlet Syndrome

For additional information contact Dr. George Sheng , Vascular Surgeon, email or call the Center at 317-583-7600.


Q. Does Neurogenic Thoracic Outlet Syndrome cause permanent nerve damage?

A. NTOS rarely causes permanent nerve damage; however, debilitating pain, numbness and tingling can cause significant life style limitations. This patient also tends to use the affected extremity less which may lead to muscle atrophy and impaired range of movement.


Q. How effective is physical therapy for NTOS?

A. With a dedicated physical therapist who is familiar with this condition, 60% of our patients never required further therapy. 


Q. How successful is the BOTOX® injection for NTOS?

A. Trigger point injection using BOTOX is able to dramatically improve symptoms of NTOS. The BOTOX injection may completely eliminate symptoms of NTOS in select patients for at least 3 months. With continued and effective physical therapy, approximately 20-30% of these patient have very good results ultimately. We offer a second injection if symptoms recur after 3 months. With careful patient selection and accurate injection, many patients avoided surgery in our Center. 


Q: How does BOTOX work in NTOS treatment?

A.BOTOX works by relaxing muscles in neck and shoulder area, this allows the pressure on nerves to decrease with time. Additionally, there is increasing evidence that BOTOX can directly decrease nerve sensitivity to pain. 


Q. Is BOTOX Injection effective in athletes with NTOS and/or pec muscle syndrome (PMS)?

A. We offer a maximum of two treatment per site. BOTOX injection is especially useful in a selected group of “overhead” athletes (swimming, baseball, softball, and volleyball). When NTOS and/or PMS is related to repetitive use associated with sports only (a patient’s daily life is not significantly affected), we can often get these athletes through the season without surgery. Additionally, we also have good success with insurance coverage when it comes to BOTOX injection.


Q. How long does it take for BOTOX to work? How long does it last?

A. 3 to 5 days to achieve maximal effect. It typically lasts 3 months minimally. 


Q. Complications related to BOTOX injection?

A. Minimal if any. We have performed more than 200 injections to date, and had no adverse effect in any patient.


Q. Is decompression surgery (1st rib resection and scalene muscle removal) curative of NTOS?

A. If the diagnosis is established accurately by someone who is experienced through trigger point injection and vascular studies, surgical treatment has over 90% success rate.  Surgery is only reserved for those that have failed conservative management. 


Q. How long is recovery from 1st rib resection surgery?

A. This depends on the patient.  Pain control is the primary reason for patients to stay in hospital. Patients usually stay in hospital overnight up to 3 days. Most patients return to work in 2 to 4 weeks with weight lifting restrictions. We start physical therapy within days of discharge from hospital. Athletes may take up to 6 to 8 weeks before reconditioning due to weight lifting restrictions. 


Q. What are complications related to 1st rib resection surgery and scalene muscle resection?

A. Nerve injury, bleeding, lymphatic fluid leak and infection. These risks significantly decrease with a surgeon how has extensive experience surgically treating TOS. At the St.Vincent Center for Thoracic Outlet Syndrome, our surgical team performs 50 to 60 of these procedures a year and have had no complications to date.