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.If you felt like you know more than the dr. I would not go with them. I think you will have better luck with Dr. Scnneider, I think dr. Jordan mentioned him to me once. I have many articles from NCBI if you want me to send them to you I could look for the ones that talk abut Cervical Ribs.
I would need your e-mail address to send them as this site wont send the whole pdf.s good luck tomorrow! Let us know what happens.
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, I would appreciate it if you could send me those articles, I will private message you with my e-mail, thanks!
Quote:
Originally Posted by nospam
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  |
Thanks Marc, yes Dr. Julie Freischlag is the doctor he was talking about. I have decided based on my most recent visit which I will post about next, that I don't need to get the scalene block. I might however, still get another BP block to the lower trunk just to be sure before surgery although Dr. Schneider didn't seem to think it was necessary. Thanks for the info about the neurolysis, the research I had done says exactly that, so I was very confused when Dr. Adelman said it scar tissue is only there post-surgery.
As for the Pec Minor Syndrome, the info I read was from Dr. Sander's publication. I think it was one of the first articles on TOS that I read after I was diagnosed. But I will definitely do some more research on that. The article made it seem like the tenotomy is a much simpler procedure and I think I also read somewhere it can be done together with the thoracic outlet decompression surgery. Do you have any sources on the type of release techniques you do for the pec minor compression? I would like to try those out and see if it helps me.
Quote:
Originally Posted by jkl626
Parbie ,If you think it is the pec minor,you could also look into the MAC test. its the nerve test that tests for pec minor involvement. I am still considering this too as I think I have pec minor involvement too. The PT definatley helps me with this too. And yes I think the Pec Minor Tenomoty is still controversial because not that many dr's do it. Ahn will do it if he finds out that is where the compression is based on his angiogram test.
Since you know you have cervical ribs, the first thing I would think they would want to do is to take them out and once they are there they can see what else if anything is going on. Weather they do full scalenectomy or neuryolosis does seem to depend on the dr.
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I am thinking of getting the MAC test too but so far it doesn't seem anyone here even does it. I will need to look into that next. I am not seeing a PT right now so currently I am not doing any exercises. Last time I went to PT recently for 8 weeks and I was worse and now have learned why, as I was doing exercises that were not targeted to my TOS. I am going to continue this mixed in with my update on Dr. Schneider on the next post.