Pec minor release 7 months post perfect first rib resection
 

Hi all,

I had a first rib resection with anterior scalene removal for ntos/vtos (compressed subclavian vein) in August 2012. The surgery went perfectly and I woke up smiling (no joke...and yes, it wore off) because all of a sudden I could move my 4th finger, which I hadn't been able to prior to surgery. The surgery gave me full hand strength back instantly. A ton of scar tissue was removed, I felt good in terms of nerve symptoms for about 2 weeks. Then, the nerve burning returned, which at first we thought was normal, given how inflamed things can get after surgery.

I had Botox in the pec minor (believed to be causing additional nerve compression) in November 2012 as a test to see if pec minor release would be effective, had a bad nerve flare and then things began to improve in January. Early February, my nerve symptoms returned with a vengeance (we assumed because of the Botox wearing off? Though it isn't definitive how much it did.) along with intermittent weakness in my 4th/5th fingers. Things in my chest are inflamed and my ulnar nerve is VERY irritated.

I'm a musician and have taken the last 7 months completely off. Since my surgery, I've tried some OT (mostly massage) but can't strengthen or exercise much because it sets the nerves off. I've also done Alexander Technique (helped a little), pilates (very modified), meditation/visualization, and have tried stationary bike (up to 15 minutes before nerves get set off), swimming (just kicking with flippers- initially ok but not anymore), and elliptical (only backwards for 5 minutes works.) I have been making progress but it is very slow and not consistent. Ativan or Zanaflex help a little but the results don't last; normal pain meds don't help. I haven't found a good PT yet and my surgeon says to stick with range of motion.

I'm considering the pec minor release, but would be grateful for any input. I was considering seeing an RSI specialist recommended to me (again, I do very little during the day right now- can't type much, etc.) but wonder if this would even be helpful right now, if the problem is truly structural and especially given that my nerves burn and I experience numbness/weakness at rest. (I might have had RSI when this started 2 years ago but now I wonder...) Given that there is a chance the pec minor release may permanently help, especially given my profession and that I need to hold up an instrument, it's tempting. I don't want to drag this process out longer than it needs to be- as it has been a long road- but I also want to be well informed about this decision.

I've read some of the pec minor threads- anyone have some recent input?

Thanks so much!

Also, I should add: at one point, we were considering ulnar nerve release/transposition at the elbow but my surgeon thinks it makes sense to do the pec minor release first and then address the elbow if necessary...

Sorry to hear you're having continued difficulty. Did you say your rib resection was perfect because of your relief from vascular symptoms or were you being facetious?

I had rib resection and scalenectomy 8 years ago but it made things worse. I don't have experience with the pec release. Do you mind saying who did your surgery? Are you seeing a TOS expert? It would be good to know that information in order to fully explore next steps.

Take care,
Kelly

Kelly,
Sorry for the confusion- I mean it was perfect structurally in the sense that there were no complications as a result of the surgery (that I know of), we relieved the vascular compression and solved those issues (my arm would swell and my hand would turn blue) entirely, and I felt good in terms of nerve symptoms completely (gone) for a short while after. I've noticed some improved from before the surgery in terms of hand strength.
I saw Dr. Donahue at MGH.
Beth

I had pec minor problems on my left side. The one and only thing I ever found that fixed them was this exact stretch, but done with a heavier weight (such as a buckwheat pillow or a book):

http://www.youtube.com/watch?v=oAY2OWGKLe8

You might start with 30 seconds each side. Do 1 - 3 cycles. 2 X per day.

Now that my pec minor isn't so tight, I do 1 cycle of 30 seconds each side, 2 X per day (morning and late evening).

I'm extremely happy with the results. I used to get severe pinching and circulatory effects.

There are some other pec minor stretches, but I had problems with them. For example, in one you are standing with your arm raised. Well I have TOS and raising my arm cuts the blood flow off so that's a no go.

Some people like the stretch where you lay over a bolster or an inflated ball.

Have you already tried this stuff? If so, how many reps, duration, times per day, etc. did you do and for how long?

You could also look into ART, manual therapy, therapeutic massage, etc. but I would still try the stretch.

Good luck.

i had the worst pec minors, not vascular but they were VERY very tight and tingly

i started out doing what chroma posted and the progressed to this

http://www.youtube.com/watch?v=WqtiwdRp6vQ

also i "milk" lol the only way i know to describe it..the area under my coracoid process, i just keep pushing into it with my fingers, it used to be tender but now its not.
my shoulder muscles are weak so i know i have to keep donig this but hopefully less and less as they get stronger and i dont have to use my pec minor to hold my shoulder up


its absolutely made a huge difference, now i can do some exercises i couldnt do before, i wouldnt get pec minor surgery unless its vascular

dear starlight, what does dr donahue suggest that you do? so sorry that you are having this.

chroma and mpl- thanks so much. I have done a little bit of self-massage but otherwise no treatment directly to the area. It has been extremely sensitive to the touch and easily inflamed since the surgery, which has been part of the challenge. Ice helps a little but nothing seems to have a lasting impact. I'm seeing a new PT on Friday and hopefully that will be helpful.

Dr. Donahue really thinks the surgery will help. I'm just concerned that some of my problems are coming from compensation/imbalances from lack of movement and strength (which are hard to work on because things are so sensitive), and that maybe surgery could be avoided.

chroma- I've also tried some gentle stretching but that also seems to irritate the ulnar nerve all the through the arm into the hand.

Interesting. My ulnar nerve problems were minor and disappeared after doing several weeks of the Egoscue exercises. But I don't know which exercises were most responsible as there were many of them.

You'll have to share that problem with the new PT and see what they can recommend.

Do your legs get hurt & get tired or does exercise just cause your TOS symptoms to flare? Valium works better than Ativan or Zanaflex for me (although I had some awesome dreams with Zanaflex!)...Valium and Gabapentin have been the only thing that have worked consistently for me.

Pec minor study
 

I posted the article on Dr thompson and pec minor study on a new thread also

http://www.science20.com/news_articl...eatment-103207

Thanks- I'll ask about Valium. Met with new PT today and have many trigger points. Strength testing caused a major flare. PT also wants me to start light cardio (I tried to explain it worsens both my pain and compression)- she said pain OK as long as it doesn't make it worse and that I can't expect not to have any pain (safe anyway??)- potentially aqua therapy, and will try and see what I can do. Got gentle exercises for shoulder stability and neck with goal of not engaging my SCM. I have started work on diaphragmatic breathing too, and healing visualizations. My plan is to try the PT for 4-6 weeks to see if it makes any difference before doing the surgery...

Interesting you should ask about my legs- it's mostly the TOS that's the problem, but my hips also seem to be off (right hip rotates in, feels like one leg is shorter than the other) and my whole left side is much stronger than my right all the way from my toes to my head.

The new study was encouraging...

Forgive my ignorance, what is Egoscue?

Egoscue is a PT who has written some books on chronic pain, alignment, etc.

You can check the web and Amazon:
https://www.google.com/search?q=egoscue+pain+free

I used the "Pain Free at the PC" book to good effect though it didn't cure my TOS (but then nothing has).