What a wonderful insightful sight! I have been creeping on neurotalk for a while and decided to become a member to seek more specific information about TOS surgery and recovery for my 16 year old daughter. I am trying to get some insight on recovery expectations based on initial cause of neurogenic TOS - injury versus overused sports muscle. I just scheduled her for surgery with Dr. Robert Thompson in St. Louis. He plans to remove her first rib, both scalene muscles and her pectoralis minor. Understanding everyone’s condition is different it appears to me that those caused by overuse due to athletic activities (volleyball, swimming, tennis, etc) have the symptoms come on gradually for no apparent reason and heal faster after surgery. My daughter's symptoms were caused by a silly volleyball accident. I am in an analysis paralysis state - scared of making the wrong decision to either have surgery NOW or wait (but for what?). She is in constant pain (varies from 3-7) and wants her quality of life back. Volleyball is history. She loves art (wants it to be her major) and playing the guitar.

Brief history: Daughter at age 14 hit her right elbow on her own leg during a volleyball exercise (2/10). Experienced instant pain (like it was on fire). Told her she hit her funny bone and that it would go away. Well, it didn’t and 2 weeks later when she told me that the pain was waking her up in the middle of the night I took her to her pediatrician and an orthopedic surgeon. She felt numbness from her elbow to her pinky and ring finger. PT seemed to make her pain worse - especially the nerve glides. Therapist noticed that her ulnar nerves subluxed when she bent her elbow. She eventually had subcutaneous transposition of the ulnar nerve to keep her nerve from moving back and forth over her elbow with the thought the nerve could heal (12/10) by orthopedic DO. Two months later the pain was worst that before the surgery. The surgeon could not figure out why and referred us to another doctor. We saw several orthopedics. Some said nerves take time a long time to heal, others offered a redo to put the nerve submuscular and some said it was in her head and she needed to be on pain and antidepressants for the rest of her life. Took her to Dr. Susan Mackinnon at Barnes Jewish Hospital in St. Louis and she recognized that the first dr did not do the surgery correctly. The subcunateous tissue was too tight around her nerve causing it to have a 90 degree kink. Dr. Mackinnon put the ulnar nerve under her muscle and also released it in her wrist area (7/11). Honestly thought we licked the problem and I had the goal of getting her off her nerve and pain medicines (Gabatril, Lyrica, Cymbalta and Nortriptyline). The pain came back this with new pain further up the arm, shoulder blade and pec area. Writing was painful. Dr. Mackinnon diagnosed her with TOS and recommended specialized PT to strengthen her core and posture. (she slouched when writing and doing art). While she has made ergonomic modification, PT seems to just to cause her greater pain. Had surgery scheduled for October 17th but got cold feet and Dr. Mackinnon referred me to Dr. Robert Thompson while we were there for her pre-op. Came back the following week for scalene block test and to see his PT for additional assessment. All is confirmed that she has TOS. Dr. Mackinnon diagnoses 400 TOS cases a year and preforms only 4 TOS surgeries a year. Dr. Thompson specializes in TOS but has a much more radical but proven solution.

Crystal Ball Question: Recovery expectations?