Quote:
Originally Posted by parbie
In Dr. Adelman’s office, I had my list of questions in front of me and spent an hour in there getting the answers (and I’m glad I did). During this time, he told showed me the CT scan and my cervical ribs, he also showed me a ppt presentation with pictures of the one surgery he performed on a patient with cervical ribs that he removed with the supraclavicular approach. His stats: says he does around 10 TOS surgeries a year and in his 21 years that would make it around 200. Majority of these have been for venous or arterial TOS. This is what threw me off. I asked him if he thought I might also have Pectoralis Minor Syndrome as I have the symptoms. He gave me a blank stare and told me he has never even heard of it. He later told me that 2 of his partners have also never heard of it. I found this odd, as 50% of those with TOS also have this. He did not have much knowledge or input on diagnostic tests, however he said that the scalene block is NOT useful after talking to a doctor at Johns Hopkins (who apparently works with Dr. Jordan at UCLA). He said this doctor (who’s name I cannot recall) told him not to adopt the scalene block as a diagnostic test for TOS. He told me he cannot be sure I have TOS but it “seems” since everything else has been ruled out, that my cervical ribs are compressing my brachial plexus. His procedure: cervical rib (without first rib) resection with a partial scalenectomy. When I asked why he would not just remove the entire scalene muscle, he did not give me a clear answer. He said he would use the supraclavicular approach because it is harder to reach up to the neck using the transaxillary approach. He said that he would NOT do a BP neurolysis because he says I would have no scar tissue since I have never had surgery. This is what also threw me off. Can’t scar tissue also develop solely from nerve damage and inflammation?
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Quote:
Originally Posted by jkl626
Parbie,
All three surgeons in L.A. and Dr. Jordan all rely on the scalene block as the best test. The fact that you have cervical ribs is the most telling sign in your case and to be honest a more clear cut diagnosis than for instance mine as I have neuroenic TOS but no cervical ribs. I believe surgical ribs can only be removed superclavically according to many articles I have read,the big question is do you need a scalenectomy as well since they will be going in superclavically that is the only way they can do a full scalenctomy.
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I'm guessing the Dr. he mentioned from John's Hopkins is
Julie A. Freischlag who trained and worked at UCLA with Gelabert, Ahn, Jordan, and Angle.
I think the scalene block procedure is unnecessary for diagnostics since you have multiple cervical ribs. All the surgeons in L.A. do not rely on the scalene block for diagnostics. Sam Ahn and Niren Angle (Orange County) do not as they have found that negative results do not rule out TOS (as was the case with me).
Why do you say 50% of those with TOS suffer from pec minor syndrome? Most of the surgeons I consulted did not believe in the necessity of the pec minor surgery (either never heard of it or never done it). I believe Dr. Sanders and his protege Annest in Denver led the charge regarding pec minor tenotomy. Dr. Thompson in St. Louis performs it as well. I haven't found any others who do. The outcomes of the pec-minor procedures are not overly positive in this forum. While I get compression at the pec-minor, they are able to release it in therapy (and I have learned some self release techniques). Do a search on this forum to see some of the downsides of having the pec minor surgery.
In regards to neurolysis, scarring/adhesions can develop from inflammation and edema. You definitely want to choose a surgeon who is prepared to perform the surgical neurolysis if necessary.
Great write-up BTW
