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DiMarie · 01-08-2007, 05:36 PM

do you have to make this decision so soon.
Will it be now or can itput off a year until you heal. To have more surgery on top of the chemo and run down body I would think will make it more difficult to heal.

I think the deciding factor in a scalenectomy and rib resection is up to the doctors finding in surgery. I do not think prior to surgery they can decide, no matte who is the doctor. Just from our own family, once surgeons got in there they found odd pathways, muscles that most modern men do not have, chest rib construction the impeded in a manner of how were they to proceed without causing more damage or compressions.

For a virgin surgery, the first plan should be less is better for my thoughts.
IN De's surgery, she ahd a first rib and scamenectomy. She developed massive adhisive fibrous bands entwined on the nerves.
Although there was Adcon-L a sugar carb substance that had been used for a time to deter scar matter. In the end, there was large debate, on the initial use in Back surgery did it really reduce. It is a natural chemical absorbed by the body.For a time there was a recall and halt on the use as testing should no improvment and it was not able to be attained by surgeons.

IF you have a problem with the vascular compression you may ahve what is tallked about by Dr Sanders where the vascular, subclaviavian passes through the scalense instead of under and then to under collar bone.

During De's surgery, she had short fibrous bands. Half of society has them although they never develope TOS. I think people with TOS have this pre-exsisting problem. The bands of scar matter that develope have to be freed from these and the cervical nerves.

Another thing Dr. T found in De's surgery. She immediatly had after her injury, a spasm in the neck like a charlie horse and from there it all spread. During surgery Dr. Togut found a fibrous band in her muscle tissue in the arm pit coming from the collar bone area. He snipped it lose. HE did not find it again until he got to the next step of the surgey to detach the first rib. Here he found the only 1 1/2 inch long band attached in the collar bone area......It had been caught in a spasm that far.

In the consult with Dr. Ahn, can he determine where the subclavian is? Can it possibly be out of place and coming from the center scalense?
I will search for this info and see if it is still on the forum archives somewhere where Dr sanders book talks about it.

Just a few thoughts for now.
Di

Laying under them traveling under the collar bone above the first rib is the subclavian artery on the left and front is the subclavian vein.
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Then the section discribes the positions in medical terms.

Scalene traingle
This area is bounded by the anterior scalene muscle anteriorly, the middle scalene muscle posteriorly, and the first rib to its base. Any one of these three structures can cause compression of the neurovascular bundle and the clinical picture of TOS.

Anterior scalene
The anterior scalene muscle has a constant site of origin from the third through the sixth vertebrea, but its point of insertion, generally on the scalene tubercle of its instertion on the first rib, can vary.
The insertion of the tubercle is between the subclavian artery and vein, with the expansion of the plural dome. Variants include insertion behind the artery and brachial plexus, or an extended area of insertion behind the artery, between the artery and brachial plexus, or extended area of insertion that includes the entire base of the scalene triangle.

The latter variant may result in the anterior and middle scalene muscles forming a vise around the neurovascular bundle. The insertion of the anterior scalene muscle merges with the middle scalene muscle in 20% of individules. In half of all individules, the insertions are overlapping the first rib, while the other half of all individules they are joined in a common insrtion.

Deep into the anterior scalene muscle lie the subclavian artery and nerve trunks of the brachial plexus. Usually the nerves pass through a slit formed by the anterior and middle scalene muscles. IN some cases, howevere, the fifth and sixth cervical roots actually pass between bundles of the anterior scalene muscle rather than the hiatus between the anterior and middle scalene muscles. In one study this variant was seen in 45% of cadavers and 21% of TOS patients.

Middle scalene muscle
The middle scalene muscle originates from the transverse process of the second through the seventh vertebrae and inserts on the superior aspect of the first rib at "CHassaignac's Retroarterial tubercle." This insertion is broader and more posterior thatn that of the anterior scalense muscle. The middle scalene mucle may also have an expansion that inserts on the fibrous septum of the pleural dome.

Lateral fibrers of the middle scalene decend past the first rib to insert on the second rib. Insertion of the middle scalene muscle in a more forward or anterior position can cause copression of the middle trunks of the brachial plexus by contact with the sharp, anterior edge of the muscle. In a cadaver study published in 1948, the most frequently encountered anatomy was that of the lower trunk of the brachial plexus resting on the anterolaterial margin of the middle scalene muscle.

Fibromuscular bands along this border of the muscle may be one of the pathology mechanisms for TOS in the absence of a cervical rib. Among 33 patients treated for TOS by Thomas et al., middle scalene muscle abnormalities were observed in 58%.
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