You ask some very good questions. For me, it's one of the reasons why surgery should be a last resort with TOS. There's always a risk, with any surgery, that adhesions (or scar matter), will form… it's just that with this particular surgery, the area of the body it's performed in makes it tricky, in that the resected scalene muscles, for example, might decide to attach to the pleura, or to the neurovascular bundle, instead of obediently atrophying up the neck as is hoped. Causing all kinds of hell to break loose, recurrence of TOS symptoms chief among them…

Not really sure how the docs diagnose adhesions as being the culprit in a given case of recurrent TOS which has already been treated surgically, except that it is so common… and it does show up on imaging techniques used in pain management measures like Botox injections, nerve blocks, etc. (like fluoroscopy with ultrasound, for example, which Dr. Jordan uses).

TOS surgeons have tried various means to wrap the nerves in Seprafilm and the like, to keep scar matter from forming - or to keep it at a minimum - but with not very good results to-date. It's a problem, no way 'round it.

You might want to have a look at Sharon Butler's site: www.selfcare4rsi.com/thoracic-outlet.html, paying particular attention to her ideas concerning fascia, which may be relevant here in terms of nonsurgical treatment for some of your symptoms…

Some people naturally form more scar matter than others, for some reason. Which is another medical mystery! I happen to fall into the "more" category; just lucky that way, I guess! :roll eyes: (I've been putting additional TOS surgery off for years now…)

My (limited) understanding of what is involved in the lysis of veins and arteries and the neurolysis of nerves, is that the surgeon literally has to go in there and scrape off the offending scar tissue. Ye gads! Some people just have all the fun.

I'm sorry that you're still having trouble despite the surgical (and, I'm sure, other) remedies you've tried to help manage your TOS. It can be a lifelong "challenge," for sure. Don't know if I've answered any of your questions, but hope you'll keep posting here to let us know how you're doing. Have a relaxing Sunday, at any rate!

Alison