July 1, 2022

Removing rib resolves serious vein injury for Madison woman

Madison, Wis. ‒ When Maureen Alley was old enough to curl her own hair, she noticed that with each elevation of her right arm to style her hair, her arm would go numb.

“I thought it was normal,” she said.

This “normal” continued for years, but one day in December 2020 it became not normal.

Alley, an avid kickboxer and brown belt in taekwondo, who is also a mother of two very active young boys, Sean, 10, and Patrick, 7, works out regularly to stay in shape for all the activities in her life. That day in December, she was doing bench press lifts — laying on your back and pushing a long, weighted bar forward over your chest — in her home gym and had decided to push herself and try to lift a little more weight, she said.

When she came upstairs afterward to make a post-workout smoothie, her life changed. Her right arm was purple and swollen — nearly double its normal size.

Alley immediately set up a video visit with urgent care at Group Health Cooperative of South Central Wisconsin and was told to go to UW Health’s East Madison Hospital for an ultrasound scan to learn if there was anything impacting her arm, but they found nothing, she said.

After a week of trying to reduce the swelling with traditional methods, the swelling moved to her chest. Meanwhile, her primary care doctor consulted a sports medicine physician who thought it might be something called thoracic outlet syndrome, which can impact blood flow to the arm, Alley said.

Since the swelling had moved to her chest, she called the UW Health Vascular Surgery Clinic and a care team immediately met with her due to the swelling in her chest. They found a massive blood clot in a vein that runs over her shoulder between her collarbone and first rib, and she was admitted to University Hospital.

She next met with Dr. Kyla Bennett, vascular surgeon at UW Health, and assistant professor of surgery, UW School of Medicine and Public Health, who explained what caused the blood clot. Alley’s clot was caused by repeated impact from her collarbone pinching a vein against her first rib, Bennett said.

Alley was given two options: Take blood-thinners for the rest of her life, which would prevent a lot the activities she likes to do, or remove the rib to alleviate the impact.

“Dr. Bennett said, ‘I'm very good at taking ribs out and I like it,' " Alley said.

The procedure is a common way to fix a rather rare condition, Bennett said.

Thoracic outlet syndrome is a term to describe three different impingements in the crowded space around the neck and shoulders, the most common is a pinched nerve — about 90 percent of cases. The other two are pinched veins or arteries, with veins being the rarest and make up about 6 to 8 percent of cases, Bennett said.

In March 2021, she removed Alley’s first rib on her right side.

“If we hadn’t taken her rib out, she would have had permanent arm swelling and blood clots,” Bennett said. “I don't foresee her developing this again in the future."

Following the procedure, Alley took blood-thinning drugs for six months and the clot eventually dissolved. At that point, she was starting to do the things she loved again.

Considering the alternative of blood-thinning medication that would have taken away her ability to be as active as she would have liked, the choice to have the rib surgery was life-changing, and one she wishes everyone who gets this condition could know about, Alley said.

“Unless you are really specialized in thoracic outlet syndrome, how would you know what to look for?” she said. “I am very fortunate that we had a doctor here who specialized in this.”

Watch Maureen's story