Scalenectomy
 

Hi there- I will be doing a scalenectomy only surgery as well. Mine is scheduled for Olctober...

why not the rib too?
most docs take that out to make room for scar tissue that will form

My doc doesn't think I need it. I had a positive scalene block and he also said that in many of the surgeries he has seen a artery or fiber our bands rubbing on top of the brachial plexus.
I am going to talk to some of his patients before the surgery next month.

i would get a 2nd and 3rd

Surgery. 1979 Jan;85(1):109-21.
Scalenectomy versus first rib resection for treatment of the thoracic outlet syndrome.
Sanders RJ, Monsour JW, Gerber WF, Adams WR, Thompson N.
Abstract
Five years ago a follow-up study of first rib resections disclosed a recurrence rate of over 15%. Many patients were reexplored supraclavicularly, and in every case the anterior scalene muslce was found to be reattached to the bed of the first rib. Scalenectomy invariably was successful, which led to this study of scalenctomy as the first operation for all cases of persistent thoracic outlet syndrome (TOS). The study revealed that most patients with TOS gave a history of neck trauma and had symptoms not only of paraesthesias of the hands and weakness of the arms, but also of neck pains and headaches. The common physical findings were tenderness over the scalene muscles and duplication of symptoms with the arms raised. A scalene muslce block with a local anesthetic was the most useful diagnostic test. The good-to-excellent long-term results following 239 scalenctomies and 214 first rib resections were almost identical, 68% and 70%, respectively, with fair results in 20% and 13%, respectively. In patients with a history of neck trauma followed by headache, neck pain, arm weakness, and parasthesias in the hand, anterior and middle scalenectomy should be considered. On the other hand, first rib resection is recommended for patients with no history of neck trauma and symptoms limited to the arm and hand, particularly those patients with signs of arterial or venous insufficiency.

And isn't getting the rib removed a more traumatic surgery? More cutting and more scar tissue and more things to workaround as the rib is removed.

Good luck with your scalenectomy, @per834.

note when this article was written-1979! Good Luck with your surgery-Scalenctomy is definatly less invasive-but I would get a 2nd opinion too. If you do go ahead keep us posted about your recovery.

Is there a newer study that covers the same topic?

Yes- one done in 1992 basically said the same thing

I had scalenectomy without rib resection for TOS (R) in 2002 and (L) in 2010. I had scar tissue issues in the L for about 3 years but after break up of scar tissue and therapy I am absolutely fine now. The medical community here in America does not like to to do only scalenectomies as it is not called a complete surgery even though in Europe and other parts of the world Dr's are opting to do scalenectomies in cases that they feel are good candidates for scalenectomies only. I am back to all my normal functions including walking my dog and playing fetch games with him and picking up the 2 gallons of milk from Costco without any pain or symptoms. I am not on any pain medication either. I got off Gabapentin this March and I am still good.
Ofcourse everyone' case is different, I am not against rib removal if needed. I almost had my ribs removed in St. Louis last August. But it was not necessary as proven in my case.
Good luck with your surgery with whatever you decide.

Obviously the determination in an individual case needs to be made with a qualified surgeon. But in general, do you know what factors contribute to someone being a good candidate for scalenectomy-only vs. a good candidate for rib removal?

From what's have read, people who have had previous trauma ( like a car accident) and no obvious rib interference, are good candidates for the scalenectomy only.

Hi u mite want to look in the new TOS medical text book just released in may '13. Should be some info. about throw 2 different surgeries. There's a link on this site n u can find it on amazon too. Ask? ? to get all the facts! I didn't even know there was a surgery called Scalenotomy. Is this when they just take part of the muscle? I had Scalenectomy of the Anterior Scalene (all the muscle was removed) and half of the Middle Scalene removed Bc this muscle goes way up the neck, is what my Dr said. I think if the space looks like the artery or vein is being compressed on Ct scan they will remove the 1st rib too.
What I dont understand about that study is if the 1strib & muscle is removed, how could the muscle reattach itself to the rib? It doesn't make sense! I would look at newer studies there are a lot on pudmed.
Where are u having ur surgery?
Best of Luck to u!

Hi- I'm having the surgery on 23rd of October at UCSD.
Dr. Brown has done a lot of theses surgeries and he said he has even seen an artery sitting on top of the brachial plexus, causing all the pain. I had a positive scalene block and I was in a car accident when I was in my 20s (with severe whiplash).
Fingers crossed...

Hi Im curious where is uscd n what kind of surgeon is Dr. Brown? I also had whiplash from bad accident 4 yrs bf I started w. chronic neck & shoulder pain.
I'm 3wks postop from 1st Rib n Cervical Rib Resction, Scalenectomy of Anterior & Middle scalenes, BP Neuroplasty. My surgeon said it was the worst fibrotic SM he has ever seen, it was as sharp as a knife. I'm having a lot of increased nerve pain n numbness I didn't have bf surgery. I think my surgeon always removes the 1st rib w his tos surgeries. I will ask him next visit.
Wish u best of luck for quick & full recovery!
Rhonda

Hi Rhonda,

University of California San Diego is UCSD. Dr. Brown has done had some incredible advances in nerve regeneration. He has done a lot of TOS surgeries at this point.
Good luck with your recovery! Keep us posted!!!

Yes, thanks. I have read that. I have done as much research as possible and then some more!

F/u and SF bay ca surgeon
 

Where did you have your surgery in SF area and by whom? Can you tell visually you are mussing neck muscles? Wondering if it looks normal and like opposite side

I just had a rib resection, pec minor release, and basically a scalene release. I thought that they would remove the scalennes completely, but in my case they just detached them from the bottom as they removed the rib. The muscles shrunk back about an inch.

Had scalenectomy in 2006. Asked that question, and if my neck would tilt. Answer to both is no. Other than small scar, there is no visual deformity. And I can hold my head up just fine :)