i'm sure this is an area of hot debate among TOS surgeons and i don't pretend to have the answers, OK?

but i must say, haven't heard of anyone using a posterior approach to get a rib out in a long time (that's an older surgery, used only for certain types of TOS redo's from what i've read). the transaxillary approach alone is more than sufficient to remove the first rib entirely.

the only surgeon that i know of that will do a COMPLETE scalenectomy with the first rib resection is dr. fred weaver at the keck school of medicine in los angeles; all the other top TOS docs i know of do some form or another of a partial scalenectomy:

dr. sam ahn i know takes 25% of the anterior and middle scalenes, for example, while dr. steve annest simply divides the scalene muscles, reattaching the cut end of the middle scalene muscle to the cut end of the first rib, to leave the nerves a smooth surface to glide on. and there's probably a whole spectrum in between the two, fern.

as far as the PT goes, i didn't mean to give you the impression that the denver protocol involved rigorous exercise. far from it! it is very, very gentle and involves a lot of ultrasound, moist heat and other modalities as well as ROM, massage and postural work. basically just retraining you how to start to rebalance the deep intrinsic muscles and to work with some of the scapular stabilizing muscles in a home program. education and self-awareness.

most of it would be appropriate for a vascular case but i can see why your surgeon might be concerned if he thought it would involve "classic" PT exercises. the program dr. annest had me in was specifically developed for TOS'ers who had just had a rib resection, though, so it is very mild. just keeps the blood moving enough to prevent a "frozen shoulder."

but as i've said, i did not have the vascular issues that you do, nor the procedures that you describe... so i really cannot say what would be appropriate. i'm sure if you call VIR they will be happy to answer any questions you may have in that regard, however.

did your surgeon elaborate as to why he would need to make 2 separate entries to remove the rib? i do know the surgeons in denver and LA do not do that. sorry, not trying to start trouble here - just thought you should know that, fern.

alison
"Be Brave"