Originally Posted by nospam

My understanding is that when the "UCLA" version of the transaxillary rib resection is performed the anterior and middle scalenes are only partially resected from the 1st rib (I've seen it referred to as a 25% scalenectomy), the subclavious is resected from the rib as well. The expectation is that these muscles atrophy and retract and do not cause future problems. I guess they are just left hanging.

The TOS info sheet Dr. Gelabert at UCLA gave me states that 10-20% of patients experience recurrence of symptoms and require supraclavicular full scalenectomy years later. Dr. Angle told me that making sure the rib is removed as fully as possible (no stubs), the chances for recurrence go down. He said he's only had one patient need the second surgery so far (I'm sure Gelabert and Ahn have been doing this much longer than Angle as he trained under them). The fact that I did not have scalene hypertrophy combined with Dr. Angle's addition of the arthroscopic camera leads me to believe my chances for this recurrence is very slim. Dr. Angle also stated that I now have plenty of space in in the outlet/inlet now.

If you want rib resection and/or full scalenectomy, the UCLA trained surgeons still remove the rib transaxillary and the scalenes supraclavicularly. I believe they feel there is less manipulation of tissue (especially the brachial plexus itself) when removing the rib transaxillary if my memory serves me correctly. I don't think they recommend doing the rib and the full scalenes the same day (I think Dr. Ahn may do it if you insist). I think the advantage of the fully supraclavicular approach is that you get the both the rib and the scalenes in one procedure vs two, but I think they have to move the brachial plexus around more and you still end up with two incisions. Someone please correct me if I am misinformed.

I firmly believe that the best approach each individual is the one your surgeon is experienced/comfortable with. I'm sure there are pros and cons to each.