pectoralis minor or scelene muscle issue
 

Hi,

Does anyone knows how to differentiate the ntos symptoms due to pectoralis minor or scelene muscles ?

My physical therapist concluded that my pectoralis was at least involved when we realized that changing my arm position caused pain. But that's all I know on the subject. I suggest finding a skilled and experienced PT or MT, if that is a possibility for you.

One thing I had done was having my Pain doctor Numb the pectoralis minor muscle to see if the TOS symptoms changed before I had my left pectoralis minor muscle detached.

He did this by injecting right into the muscle while looking at a ultrasound to make sure he injected it in the correct muscle.

This chart is older , but I always thought it was helpful- in post #1 useful stickies-
http://tos-syndrome.com/newpage12.htm

Pectoral minor dominance is usually related to 2 things-

1. anything cervical. If you have cervical pain, issues then the Pminor starts taking over since its not linked to the cervical spine directly and the brain recruits it for more tasks in moving the hand.

2. posture. all of us who work on computers with hunched shoulders and infrequent breaks will have some amount of pec minor dominance especially on the dominant hand.

question is what amount of stretching works, is safe and dosage, i.e. how many times per day etc. there is a point of view that instead of stretching, one should just practise "relaxing the muscle" but in my experience stretches do help more than just relaxation methods.

Many thanks!

As with any other treatment program, proceed cautiously with pectoralis stretching. I had an RSI specialist recommend that I stretch my (visibly shortened) pecs, and I went at it with a little too much excitement. By stretching too much too fast, I think I just caused further compression of the nerve, and therefore worse pain. I only later found out that conventional pec stretching can sometimes worsen TOS. So, to repeat, take it slow!

Thanks JNT, so what worked? How many stretches, method, number of times/day?

So far, nothing. If stuff had worked, it's unlikely I would be spending so much time looking at this forum (pardon the dark sarcasm).

My symptoms mimic RSI, in that if I avoid problematic activities, the pain goes down fairly quickly. The trouble is that so many activities cause pain that I end up more or less partially disabled.

Right now I am on a program of lots of myofascial release, pieced together from my physical therapist, some books, and my own experience. I only started a couple weeks ago, and so far I haven't noticed a ton of benefit. But on the other hand, it doesn't seem to be making anything worse, and given my past experiences that's a step in the right direction.

Sorry I can't be more helpful.

Hi, I understand your frustration, grapple with the same issue daily.
The fact that Pec stretches aren't working for you, would imply (to me), that your issue is really scalene related/and or cervical. Please try taking a tennis ball and (gently at first) massaging your scalenes. Does that make things better? If so, it might be worth continuing.
I can do pec stretches provided my neck isn't flared up. If my neck is flared up, then chances are, your pec stretching will backfire.
Another tip I recently learnt. Being more and more bound to the bed etc, I was propping my head up and reading. It made things much worse. If you must do this, make sure the pillow and support are from the shoulders and not the neck. Otherwise, it forces the bottom of the neck into further flexion, and activates the scalenes.
The things we learn..:rolleyes::o

Thanks! Will give it a try. I have been doing scalene massage with my hands, along with a solid amount of neck stretching every day, but maybe a tennis ball will work better.

One interesting way to note if your pec minor is very dominant is to see your hands. If they are internally rotated, chances are pec minor tightness exists. Basically when you stand, back of your arms face forward as versus thumbs.

Great test Akash!

I had a bilateral pectoralis minor release 9 months before my first rib resection/scalenectomy. For me pec minor was more radial/median nerve entrapment and scalenes were median/ulnar nerve entrapment.



When your hands fall asleep, pay attention to what fingers fall asleep first, or go cold first/most. Then compare the hand chart: https://nervesurgery.wustl.edu/ev/ha...s/default.aspx

Then compare this to the where the nerves run through the Thoracic Outlet:
https://www.amtamassage.org/articles/3/MTJ/detail/1666

Tos
 

Peck minor causes more tenderness accross chest and under collarbone apply pressure from the front scalene muscle go into spasm an pull up on the 1st rib apply pressure from the top into your anterior and medial insertion points you will be able to tell a difference usually scalene and 1rib is the primary problem and peck minor is more of a secondary entrapment point I've had a 1st rib resection with anterior and medialscalenectomy and a peck minor tenotomy peck minor relieved anterior shoulder/sub scapula/and rib pain is was out pt and back to work on day 2 no meds 1st ribeesectionwasnt horrible but I was down for about 3 weeks nothing like the drama people hype if up to be but everyone is different?

Hi CanadianRN,

What type of tos u are having and post surgery how are you doing now?
What was the cause of your tos? Troma or something else.

Regards
Ramdas

Hi Canadian RN! I'm a Canadian Ultrasonographer! I was DX. With Ntos on my right side that I've been doing ultrasound with for 14 years and recently had a scalenectomy and 1st rib resection by a Doctor that came up from the Mayo Clinic and specializes in this procedure! Trust me when I say I did my homework! I am 2 mos. Post op and continue to have symptoms. I was OK for awhile but now I'm 2.5 mos. Post op and all the symptoms have returned! Cold hand, discolouration, ring finger pain, wrist pain (mainly radial aspect). How did your Doctor determine the pec. Issue?? I've been told by PT that it's foreshortened and atrophied but no surgical intervention. any advice would really help. Thank you.

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