When my scalene block with Dr. Vernon Williams was unsuccessful (2010) I was never able to get back in to see him. I was suffering and his office only offered me an appointment 6 weeks away. My wife and I assumed that I did not have TOS. I sought out a new neurologist and neurosurgeon. There was evidence of cervical radiculopathy and I went through with cervical fusion surgery which was successful in eliminating many of my symptoms.

In the year following the fusion, some of my symptoms did not disappear and started getting worse. My doctors were overly thorough in verifying the fusion was successful. I also had another EMG which eliminated carpal and cubital tunnel as well, but had some suspicious C8-T1 readings which could point to TOS.

When I started seeing the vascular guys, they all said that failing the scalene block doesn't mean you don't have TOS. Gelabert wanted me to repeat the scalene block as it is his main indicator for selecting surgical candidates. Dr. Ahn and Angle both felt the scalene block was unreliable and didn't think I needed to repeat it.

I also had the MRI of the Brachial Plexus from Dr. Tsuruda in Pasadena that Dr. Williams had ordered in 2010. It showed neural edema and increased neural signal. Dr. Gelabert said Tsuruda does good studies and there was no need for Collins' study. Gelabert also wanted me to have the SSEP test since it was likely I would fail the scalene block again.

Dr. Ahn completely ignored all of my prior tests and said I had clinical signs of vascular and neurogenic TOS but would not discuss surgical options until I underwent his angiogram/angioplasty. Dr. Fujitani wanted to repeat everything, including my cervical fusion workup so I didn't want to reinvent the wheel with him.

Dr. Angle looked at all of my previous studies but said he mainly relies on clinical evidence as the imaging never tells the full story of what he finds in surgery. Clinically he found evidence of both vascular and neurogenic TOS. At my request (he didn't find it necessary), Angle ordered MRI/MRA which showed evidence of venous TOS with my arms overhead. None of the testing showed exactly what Dr. Angle found in surgery. The costoclavicular space was extremely tight on both sides. My left brachial plexus was fused to the rib. My right rib was in an odd position and was attached to the lung pleura.

Dr. Ando was key to me choosing to go through with rib resection surgery. Originally, I wanted to just do therapy or get scalenectomy only. My previous therapists were never able to get my 1st ribs to lower. In two weeks of trying, Ando was not able to get my 1st ribs to budge. However, he did reveal to me why. The ribs below were pushing up on the first rib (subluxations and torsions). This convinced me that my problem was rib related and not scalene related. My ribs have been easier for Ando to align on the left side since I had the resection. I will start therapy on the right side next week.