Anyone have the pec minor surgery?
 

Anyone have the pec minor surgery> Ijust read about it and was wondering...

I did - both sides done in 1 procedure.

I'd recommend having a pec minor nerve block done first, to see if you will get any relief. Just be prepared to lose some functionality. It's a trade-off for less pain.

I had the nerve block done on 1 side and got lots of relief. Since my insurance was about to expire, I went ahead with the procedure and had the release done bi-laterally. Additionally, I had an extra scalene on the left side that was removed.

Any questions?
Anne

question- what does the pec minor release involve, and, what/where is the pec minor nerve block? I've read about an accupressure pec minor release ( i think). I'd like to have another option to put infront of my PM doc when I see him early next week.

Thanks for the quick response.

I have had bilateral rib resections and scalenectomies done in '00 and '01. At this point, one of the biggest issues is the chest pain and shoulder pain when I am active. As a result, I think that my neck muscles are more out of shape and that is contributing to more of the TOS neck/headaches. So I am hopeful that this surgery would lessen the shoulder and chest pain to allow me to address some of the other TOS issues in ways other than rest and meds...

When you say loss of functionality, how much do you mean? Just strength or dexterity too? If you could give some idea of the impact of daily life, that might be helpful for me to understand the extent...

How painful was the recovery? How long? I would travel out of state if I were to do this, how long were you in the hospital?

I have had many nerve blocks, both botox and marcaine (I think...) that have helped the shoulder pain... just need to find out where they were putting them, let 'em try again to confirm...

It has been a long time. I am trying not to get my hopes up too soon.

Thanks for any more info you can give me,

Hugs,

Wylie

attached image of Pec Minor muscles
 

Hi dabbo and Wylie!

The procedure is done by cutting a 2-3" horizontal line just below the collarbone. Look at the attached image, the top where the pec minor muscles attach to the shoulder, this is 'snipped' which renders the muscle useless. (a nerve block is done in the same location - they just inject the nerve that controls that muscle, putting it 'to sleep') It prevents the muscle from going into spasm, which in turn prevents the scalenes from going into spasm, which in turn is supposed to prevent the occipital migraines.

It did not prevent the migraines for me. :( It did lessen the rock-like scalenes and constant spasms in the collarbone area. I'm also not as sensitive there now(ie: fewer trigger points). But the migraines persist.

Wylie, I'm really struggling with controlling my flare-ups. In an attempt to lessen the meds, I'm told by my PT guy all I can do (post pec minor release) is stretching and moist heat. I got a scholarship to the local YMCA and am using their indoor walking track, exercise balls (to stretch the sternalis muscles) and hot tub. Simple daily activities (brushing hair, teeth, dressing, writing) still cause me problems. I can no longer mop, dust, vacuum, pull on stockings, lift a baby, hold a childs hand, do anything overhead... I tell ya, most days I'm just grateful that I can still think, cause that's just about all I can do! The loss of strength AND dexterity isn't related to the pec minor release - that's from long term nerve impingement. The lifting, pulling carrying stuff - THAT's the limitations from the pec minor release. Additionally, you may suffer overworking your sternalis muscles (over your sternum) and forearm muscles, as these try to compensate. A whole new set of problems. :Bang-Head:

It's all a trade-off.

The procedure is an easy one (compared to a rib resection). I had an overnight hospital stay in Denver and flew home the next day. The surrounding muscles (on the right) were ****** for months and very bruised. Really, a year. Ice, ice, ice. I recommend that the surgeon do nerve blocks prior to a release... the muscles will be MUCH happier! I had one done on the left (the side that also had a scalenectomy done) pre- surgery and I had almost no bruising or burning pain.

Happy to share my experiences!
Anne
(this took about 1 hr to type and my hands are swolen!)

I also had it done, on the right. Was abt a 20-minute procedure, and I had a wonderful hostess in Denver, so managed outpatient. Then flew to PA 2 days later and juggled/shuffled bag, x-rays and coat in line at the security checkpoint for an hour - absolutely in AGONY time we boarded :yikes: (The plan was for a consult only, no surgery according to Dr A, so made appts to see Dr T and Dr Schwartzman in PA after, then fly home, save one flight leg and some cash. As with most careful planning....:icon_wink: )

Anyway, it was a tradeoff in ways. The lifting, pulling and carrying I can't do anyway because the RSD makes it too painful unless the item is light - one of our 7-month-old kittens is getting past my limit, he's such a chub! What I really noticed for some months was more pain and imbalance around the scap, because the pec minor attaches to the top of the scap, and now that "anchor" was detached. After several months it became better, or I adapted, or both. I do still have as many t.p.'s in the trap and cervical area, and get headaches if I don't limit computer time, but I'm better at massaging the worst of the tension out myself. And the spinal cord stimulator has brought the pain in the arms and hands way down, just as long as I don't overdo.

With surgery the first week of November and not allowed to do much til middle of December, I overdid it just getting a very minimal Christmas together this year. Next year I think I'm going to pay a college student to help out with decorating and shopping and sending cards and packages - just can't do it myself, but not Christmas without it.

Happy New Year Ann! And best wishes to you Wylie!

beth

Thanks for the insight...
 

Thanks for the information, Anne and Beth.

I was pretty excited to find out about this procedure and was very hopeful that it was the answer... if I could get the shoulder pain and that nasty stabbing the chest to go away, I could do more and increase core strength, which would hopefully then help the headaches... Annest told me if I could live with things as they are, I should but it is hard not to reach for something every once in a while. As I am sure that you know.

BUT after hearing about the trade offs it does not sound like this is the answer I was hoping for. I have a 2 year old and at this point, he goes to daycare and while he is away, I consider it my "job" to keep my pain under control, symptoms in check so I can be the best Mommy I can be with TOS. I cannot further compromise what I have and I need to be able to pick him up (ouch) on occasion. And I cannot rule out having another baby someday.

I am grateful that the two of you took the time to answer, I know how typing bothers you. You have been extremely helpful. I talk with docs on Monday regarding if I am a candidate but not consider doing it in the near term.

Gentle hugs,

Wylie

have you heard of this pec /chest stretch before?
it is really a good and easy gentle stretch-
if you can't do the roll because of discomfort - just lay out flat and place the arms out in a comfortable but slight stretch position and see if you can advance up to a rolled towel or pillow later.

it's post # 4 but the whole thread has some good info-
http://neurotalk.psychcentral.com/sh...ad.php?p=30184

Wylie- you can also do botox injections to relax the pec minor a bit- not as thorough or long lasting as teh surgery, but also not permenant...if that makes any kind of sense.

I am also a mom, with a 1 and 3 yo...can't really contemplate surgery at this point because of the lifting thing. Kids NEED to be held sometimes. no way around it.

I have felt better in my arms with the botox injections, but my back is a bit out of whack now. I think I am due for a second set. that means mine have lasted almost 4 months. Of course, they took a month to start doing anything, too...so I got about 3 decent months out of it. The hardest part is not overdoing it once i feel better. I think that's why my back is all messed up...I was lifting things I shouldn't have been.

Johanna

bump for ann

Post pec minor release-long term results
 

Astern, Beth, ...
Can any of you who've had the pec minor release let us know how you are doing now that some time has passed. Was it worth it to you? Do you have any problems that have occured or long term relief? Any insights you can share for those of us deciding on the surgery (in addn to the value of the block)?

Hi fern, my procedure was done early April of '05.

I can no longer pick up things away from my body. I'd be afraid to pick up a child.

I find that my rt. bicep tends to 'flip over' when I use my arm in a certain position (flossing my back teeth for example), this is VERY painful, like a cramped foot would be!

I'm also experiencing my sternalis muscles and biceps overcompensating for the lost pec minor stablization (per my PT), so now I'm getting tearing sensations in the sternum and arms.

On the plus side, I have fewer trigger points and a less-sensitive collarbone area. My scalenes spasm less often, but still give me problems.

It's not a complete fix by any means - merely a trade-off for pain/problems. I would highly suggest having the pec minor nerve block done first, to see if you get any relief. This is what I did, although in my situation the clock was ticking for my health insurance - I had literally 2 weeks before it was canceled, so I opted to have the pec minor release done bi-laterally. Had my insurance not been canceled, I'd have tried the blocks until they ceased to give me relief.

Hope this helps you,
Anne

Thank you so much Anne for your input. I had the block in Denver but it was a test to see if the muscle was affected and how I might feel after the release. Are you saying that there is a block that gives longer lasting relief--like botox or something? I don't want to have surgery if I'm going to trade one set of symptoms for another.

that's not what I'm saying.
 

No, I'm not really aware how 'long' a block is supposed to work. I was told, in my case, that it may last a week to a few months. It lasted a month or so for me. I know because the side I had the block done on tolerated the pec minor release (and scalenectomy) very well, until it wore off... then it was angry! The side done without the block didn't tolerate the release very nicely - bruised, burning and angry from surgery onward.

If you aren't ready to trade sets of symptoms, I'd suggest that you not do it. It shows you may have enough functionality to manage the symptoms "as-is".

:hug:
Anne

Anne-just to clarify, because I'd like to try a block. Is the one you had not what Dr Sanders uses to diagnose? If not, what is it? Do you get it from a pain dr? do you know what is injected? With all the post surgery issues, I think it makes sense to try everything out there even if the quality of life sucks in the meantime. I'm not comfortable "managing" as you say but things like repeat surgeries and RSD really concern me.

I have no idea what Dr. Sanders uses to diagnose TOS.

I assume all "nerve blocks" are done the same - I think Beth or some others here may be able to pinpoint what it is you are needing to know, ie: what meds are injected and where. My pec minors were injected about center-muscle.

Nerve block are similar in nature, and in some people can last a few weeks to a month, in others can last two hours...just depends. You can do trigger point injections (a lidocaine or marcaine injection into a knotted muscle) or botox into the same places... trigger points i think the goal is to relax the muscle by making it not hurt any more. Botox relaxes the muscle by not allowing it to contract.

The trigger point injection of lidocaine or a botox injection will do similar things to a nerve block (relax the muscle) but will generally last longer than a nerve block. I haven't done trigger points myself, only botox, but I think People get trigger point injections every few weeks, botox can go 6 weeks to 6 months, though I haven't heard of 6 months from anyone except the doc. I expect those people aren't hanging around here.

poeple get either type of injection in scalene, trapezius, and pec minor muscles depending on what is spasmed.

Pec Minor Block
 

Dr. Agnew injected me bilaterally 3 weeks ago.
I was the BIGGEST baby
Trading one pain for another.
After it was done and over
I had maybe 5 hours of NO pain, NO sciatica, NO leg & foot stiffness, NO tingling & numbeness in the toes.
However, the headaches and cervicle pain was still there.

After it wore off, I had a flare like an angry PUMA for weeks.

My 10 minute computer timer just went off...wish I could stay and read and share

Dr Sanders has updated his page to include quite a bit about the pec minor problem and procedure. It's interesting, although the literature described the problem, there was NOTHING out there about anyone doing pec minor procedures when I was dx'd and sent to Denver to have it done in Oct 2004.
When Dr. Annest said he had never done the procedure before, I was really surprised. Turns out, I may have been the very FIRST patient to have had it done---if I'd know that then, I'd have been MUCH more nervous!!! :eek:

Dr S. says either novicaine or xylocaine is used in the block.

Although my shoulder blade initially felt MORE unstable/like it was winging more, and was uncomfortable/somewhat more painful for about 12 months I'd estimate, the shoulder blade is better now, less overall pain than before the surgery. The unstable feeling is gone as well, guess other muscles have adapted. What has NOT changed is the pain below the collarbone, that's been with me from day one of my injury, and I think always will be, dang it!
It's present on the left side as well. NOT a good place to be touched!!

Here's the link to Dr. Sander's page:

http://www.ecentral.com/members/rsanders/