TOS surgery for transverse processes of c7
 

Hi im 24 year old male and i have been diagnosed with bilateral TOS both Neuronic and Vascular. The Doctors have said mine is only a mild case, but i am still getting painful symptoms.After analysing x -rays We have discovered that i have elongated transverse processes of c7 ( left side being longer) and the doctor says that seems to be the underlying cause.

The Neuroligist also told me that the cure for this would be surgery, he said that in my case removal of the first rib would not be necessary as it wasnt the first rib causing the problem. He said it would be a procedure where they get in there and shorten and the elongated transverse processes to make more room in there, also possibly a particial scalenectomy.

I have not yet seen the vascular surgeon yet so i am waiting on hes opinion.
I ahve done 2 months of chiro and pyscial therapy and i am showing improvements however symtpoms keep returning.

my question is the fact that i have bony abnormality, does that make me a better candidate for surgery? and does that mean i will have a better outcome of surgery?

i seem to read alot of people dont have a good outcome with the first rib removal so i am happy that has not been suggested.

has anyony had a similar kind of surgery where its just scalenectomy and shortening of the transverse processes?

your opinions would be appriciated ,

thanks

Hello,
Did they mention , or show you on the imaging? how much longer or the size difference between L & R elongated transverse process? Just curious, seems like they should clarify that point for you. Although it may not make a difference it would be nice to know if millimeters vs a centimeters or inches. If a very small difference maybe more sessions of PT & chiro for a longer time might take care of it.

I had about a 6 pain level a few times, but with rest & good PT ( & self care at home) it would come back down to 3-4 and then even until I did too much at one time( thinking I was OK at the time, but I wasn't quite there yet).
It takes a while to learn your limits, and then to learn how to slowly keep progressing forward without the backwards steps. It took me about 2.5 yrs to get to a fairly comfortable place. I still go to my chiro monthly for US, LLLT, IF stim therapies if needed - as well as adjustments as needed (hyper-mobile so I go "out" of adjustment some times).

I don't recall anyone specifically having surgery only for elongated transverse processes, but one of our other new members has also asked about a similar issue recently in a thread.

I will tell you that in my opinion :) more sessions of expert & quality PT or DC might be very beneficial.

If you can describe your pain or the worst of your symptoms we might be able to suggest some home care therapies for you.

Did the pain & sx start recently or has there always been some lingering discomfort?

The pain and lingering started about August last year... Very mild nerve pains in my left hand but constant. . then it slowly got worse and worse .. At that stage i didnt think anything of it and kept to schedule with my gym routine and hit it harder then ever. I started getting good gains and out on about 5 kilos. then it got real bad. . i was getting pains in both hands and shoudlers and neck constantly thats when i knew something was wrong.

The left side is alot longer then the right, the left side being long and pointed.
I have since then stopped working my chest and delts and i only work my back muscles as directed by my physio to straighten my posture. Its working my posture is alot better and symptoms have definately gotten better but then pain is still there, pain is less but still there.

All of the doctors i have spoken to ( Physio, GP and Neuroligist) Have all said that removal of the first rib is not neccesary in my case. They said a neurolysis of C7 route and shortening of the transverse process would be the procedure. But i dont know what the surgeon will say seeing as he will have the final word.

But physical therapy defintaly has helped me at this stage, but hasnt provided me with total relief if that makes sense

Do you think it is possible to ever get back to being completely symptom free?

Worste pain i get would just be general tingling aching pain from my shoulder to my fingers. Not to bad though. About a 6 out 10 at very very worste.

I didn't realize you lifted weights.

Hypertrophy of muscles in the area can cause space limitations also.

You didn't always have pain or symptoms , so something changed for these to start.
If you focused on the upper body muscles that are in that area and they happened to get big enough to crowd the tranverse process and nerves???
I'm just thinking if you change your workouts from muscle building to a fitness, posture & flexibility type- you might see pain decreases as well as avoid surgery. Or even stop workouts for a time and substitute walking, and less upper body intensive activities to se what happens with the pain.


One of our members after many years has found something that is really giving him relief, here's a thread about it.
http://neurotalk.psychcentral.com/thread149529.html

Perhaps if you try something like it- things will turn around for you.

One of the things with surgery is the scar tissue & adhesions that can happen afterward, and they can cause just as much trouble as you had before.

Jo Mar / Hellothere,

It's probably an understatement to say that TOS and weightlifting are not good fits.

This is unfortunate for those that love this activity (like me). I'm finding out the hard way. I go weeks feeling fine and then bam...scapular burning all over.

I have a bad feeling that like you Jo Mar, it's going to take me a few years (and unfortunately a lot of pain) to find that "activity comfort zone." I don't think I can just switch gears and do yoga or something. It's not my personality.

At some point though, pain (and possibly surgery) will force me to adapt.

KY

Hey thanks for your responses.

I have changed my workout routine alot. I dont do any Pec or or shoulders building excersizes I jus strech the pec minor out everyday. I have been building on the back muscles that help my posture followed by alot of streching and this helping me alot.
Also i do anterior scalene strech 3 times a day and never gliding excersizes.
I think the symptoms i am getting are more on the lower end of the scale, what i mean by that is i read alot of people on here have disabling symptoms loss of range of motion, atrophy ect. I dont have any of that i have full range of motion the only symptoms i get is pain, tingling and fatigue. Hence the diagnosis of mild thoracic outlet syndrome.

Also working out my back doesnt cause me to much discomfort during or after excersize, so as long as i dont take it to far i could be alright. Only time will tell i guess .

I read on here that if a cervicle rib is present that surgery usually has a goos sucess rate. Since a cervical rib is a boney abnormaltie would that put elongated transverse processes in the same category? They are both abnormalities.

Hellothere,

The elongated C7 transverse process could throw you into the category of having a bony abnormality. It would lead to an even tighter space for the outlet. I have an elongated C7 transverse process on my left side, too. It was caught a few years ago before I became symptomatic on the left. The doctor told me that it would contribute to TOS. I was officially diagnosed with TOS on the left side about 2 weeks ago but hope to avoid surgery.

I had TOS surgery on my right side about 8 years ago. I turned out to have an abnormal first rib with a large growth on it. The one-time injury compromised the area leading to progressing nerve symptoms. I finally threw in the towel and decided to try the surgery. I am still nerve symptom free (on the right) but this is not a guarantee of success on the other side. Knowing how bad it got before I opted for surgery has me quite concerned about the coming months. I start PT next week and I just hope it works better than before.

Good luck!

What kind of symptoms are you getting on your left side if you dont mind me asking?

And did the docotor specify what kind of surgery he would recommend for that left side with the elongated transverse process?

What exercises do you do exactly? Curious what has been working vs. not.

I think I'm in a similar boat. My symptoms are not severe. Every now and then my pain hits a 4 or a 5, but that's infrequent...even with workouts. That said, the pain level may be irrelevant as my doc things the presence of a bruit may indicate that sooner or later, I may be in the more severe symptom boat.

KY

The doctor who caught the elongated C7 transverse process was a physiatrist, not a surgeon. I haven't seen a surgeon for the left side yet.

I'm having typically nerve pain/sensations that are probably common for TOS at least my doctors immediately suspected TOS based on the symptoms. I recognized the symptoms from before but hoped it wasn't TOS.

Is it possible for TOS to occur in a phases, for instance my physio told me that my chest and anterior delts were way to tight and strong for my back thus pulling me foward and giving me the rounded shoulder look . after these past few months i have been reversing that and i am improving.

I wonder if i could maybe even permanantly fix this by continuning to balance myself out

Sounds like a good theory to me. If your tos slowly developed over time, things slowly got worse, and as you over compensated with different muscles other things got out of wack. By slowly correcting this you could be one of those that does get better. You cant look it as a quick fix though...if your on the road to recovery, keep going, it may take a couple years be prepard for the long hall.
From there, maintaining whay you have learned about your body and what sets it off you should be able to live a "normal" life. I think you will always have to be aware of it though.
If you are improving with therapy that is great!!! Im sure you know its a big commitment, but well worth it. Wish I could say therapy has worked for me, but so happy when I hear someone who is having postive results.
all the best.
Cheers,
Jay

Well it was a period of about 8 months where it seem to progress and get worse. Prior to that i had no symptoms what so ever, and now they are backing off again after making alot of changes to my posture, sleep posture and gym routine.
The only abnormality found was the elongated transverse processes and the neurologist seems to think that is the cause of it. Im very eager to meet with the surgeon and see what he has to say about it, because the neuroligist told me that all they would have to do was get in there and shorten the ends of the transverse processes. He said it was quite a simple procedure.

Does anyone know if a vascualr surgeon or a spinal surgeon performs that kind of operation?

I'm curious of this myself.

In my case, I don't think I have any "bony abnormalities" that are creating my situation. Or at least, I haven't been told so yet.

I do know that my training routine had me forward rounded and internally rotated to the point where I had shoulder impingement. Through pec minor stretching, scalene stretching, and scapular stabilization work I feel like this has improved dramatically. At the same time, my neurological symptoms have dried up as well. So I'm wondering if fixing this fixes a lot of the problems.

I'd much rather fix TOS this way vs. surgical. (Although again, my arterial situation may force my hand in a way I don't want to).

KY

I also get a constant pain all along the back of my neck, causing headaches.
This pain is there pretty much everyday?

Does anyonw else expericne this?

Also after the mobilization that the physical therapist does im always sore around those areas ( first rib, shoulder, neck ) for days and days to follow.
Does anyone else experience this ?

Absolutely! I have to take to my bed for near on two days following mobilization of first rib and long C7 transverse process :(

Hi Chivers

Jus curious are you experiencing bi lateral symptoms? Or just symptomts on the side with the elongated transverse process?

How are you going with your Physcial therapy, are you showing improvements? and how long have you been doing it for?

Have you spoken to a surgeon regarding your situation? if so wat did he say?

thanks

[QUOTE=hellothere;778594]I also get a constant pain all along the back of my neck, causing headaches.
This pain is there pretty much everyday?

Does anyonw else expericne this?


Oh yea...not the constant pain along th back of the neck, but I got the headache or migriane everyday, starting from the back of the head up.
Nasty isnt it...

Lately i have been getting, very wierd sensations threw my arms all the way to my finger tips. Very differnt to the symptoms i have been experiencing prior to this.

It usually happens at night when im resting right before i fall asleep, I get a rush of pain mixed with tingling (almost feels like electricty going threw my veins) then its followed by the whole hand getting itchy and then it feels like my fingers are pullsating, its a very wierd sensation. My chiropractor told me this is a good sign and it means that i am getting back feeling and sensations threw my arms as the pressure is relieved of the nerves.

This does makes sense to me beacause my symptoms have been improving and i could dare even say that i am getting better.

Jus curious to see if anyone has experienced a similar thing?

Okay. I have to bump ^ describes what happens to me at night pretty well. I just assumed it was bad. Am I wrong?

The pulsating is spot on. I used to get that really bad.

actually youre the guy with winged scaps too, so your case might be similar to mine. altho my ribs can elevate. i hope its not "fibrous bands" or wahtever

Surgery to shorten C7 transverse process
 

I have the exact same question as the original poster. I can actually feel my elongated C7 transverse processes in my neck, and my incredibly tight and painful scalene muscles seem to stretch around them. But the vascular surgeon at Stanford just wanted to do the standard scalenectomy and first rib resection on me – he was not familiar with surgery just for the transverse processes.

So if anyone can answer the original poster's question, you may be helping out a lot of us.

1) Has anyone had surgery to shorten their transverse processes?
2) If not, is anyone aware of a doctor who has experience with this specific surgery?

re c7 tranverse
 

Hi there
My surgeon highly recommended surgery for me due to having c7 transverse processes.He calls them cervical ribs, elongated transverse processes are just one type of cervical rib. These ribs cut into the brachial nerves that go between the middle & anterior scalene muscles and narrow the space. So they compress the nerves n. can cause scar tissue on them. I had severe narrowing of the artery which showed on a 3d Ct scan.
If u have. Comp of the vein n hypertrophy of scalene muscles I would u would benefit from having the 1st rib removed also. Did u have a Ct scan? U being young u probably dont have a lot of scar tissue built up yet. I think u should stop doing heavy wts can cause rounded shoulders which comp the tos area. See if this helps w numbness. If I were I would n see what happens over the next yr. U dont need to rush into this major surgery rite. now u have time on ur hands! I am 50 yrs n had 30 yrs of bone rubbing on nerves which caused a lot of scar tissue wrapped around the nerves.
Also make sure ur surgeon specializes tos!

I had a supraclavicular 1st rib resction, costotransversectomy, scalenectomy, BP neuroplasty. I dont know the size of transverse process or how much was removed but a good? for my Dr next visit. I think my Dr always removes the 1st rib n muscle but not positive. I assume its better to be safe than sorry. U wouldn't want to be opened up again n cause more scar tissue.
My Dr is Dean Donahue at MGH in Boston. He specializes in dx n treating tos all 3 types.
He cowrote a med text book called Thoracic Outlet Syndrome w 4 other drs. around the country which was published in may 2013

hi ..i had bilateral elongated transverse process...it is one type of c.rib..my left side was more painful then my right side...my dr did a scalenotomy and resection of the transverse process..im doing v.well now..my right side is giving problem now..so i think i need to do my right side soon...

Considering surgery via underarm
 

Hi everyone, just wondering if you had the operations via underarm or through the top? I am looking at removal of cervical rib and 1st rib with removal of anterior scalene only via under arm on th left side.