Pec Minor?
 

Hi everyone :)
Not feeling good as of late :( I have a few Q's for everyone. I know someone just had a pec minor surgery it was brought up to me I may need one also, but I had already had my TOS surgery the rib removal and scalen along with symphatic nerve for RSD. Has anyone else had this done after your TOS surgery? and did it help? I know I'm willing to try it for my pain is rising again, and it seems that my pec minor is constricting my nerves and hurts really bad. So any help would be good thanks...

Hi Flippin,
If I am not mistaken I think Beth did. Hopefully she will see this and answer you soon. I had the bilateral pec minor release 2 weeks ago. DR Sanders is pretty certain that's where my compressions was. And I believe it was too because my symptoms dramtically improved. Hope this helps! :) IHtos

Hi flippin',

I had my pec minor releases (bi-lateral) done AFTER the TOS surgeries.

It helped, but not enough to warrant losing the stability and movements that the pec minors give. My situation was weird tho - my insurance was running out in 30 days. I went to Denver and had nerve block done on the right side. It helped (and 24 hrs later I was having the surgeries). If my insurance was continuing, I would have opted to do nerve blocks for as long as they helped BEFORE doing the pec minor releases.

Now I'm experiencing tearing in my forearm and sternum - the areas that are trying to compensate for the pec minors. Also having lots of pain in the arm pits and pec minor insertion areas. Don't know why. Scar tissue?

Hope this is what you were looking for. :hug:

What is bothering you pain-wise the most right now?

Anne

astern, flippin
 

astern--just wondering-what does Dr Sanders say about your sypmtoms post pec-minor release? Is there anything that can be done like strengthening or should time have a benefit to your situation? i really hope you get some relief post multiple surgeries.

flippin--have you had a diax telling you its the pec minor? what was the effect or removing the symphatic nerve?

Hi Fern,

I don't see Dr Sanders. My surgeon was Dr Annest and I havent called him about it. Our last conversation (1 yr ago+) was that there was nothing else he could do for me - more surgery was not an option, and dangerous for me and the only option left was a SCM implant. I need a Dr locally who can deal with 'me'. I have a Feldenkrais therapist who dx me with why I'm hurting in my upper arms and sternum and she gave me helpful hints on how to cope. But it's still difficult NOT to reach for that thing or use my arms away from my body/center of gravity.

astern thanks ! that is what will happen to me, I will get blocks done to see if it will be helpful to me. I worry also since having the procedure done I will have to use other muscles to compensate and I have other issues also concerning RSD, and other muscles that are doing the same thing. I do not want a implant and am afraid I will be told the same thing nothing else can be done and be released to PM which is ok but I think I will do or try to have blocks as long as I can. I will let you all know.

Astern, Hi
 

Astern, I wondered who else had pec minor release surgery. I'm sorry it hasnt helped you. I wondered about how the loss of the pec minors has affected those who had it done. It's the only surgery I have had done. I hope that it's the only one. Crossing fingers here. Did you notice all these things immediately after the pec minor release or has the instability and pain in arm pits been a progressive thing? Thanks!!

Flippinout, I got a pm from Beth, and I think she also had rib/scalene removed , has RSD, and then the pec minor release on 1 side.

Hi ihtos,

Immediately you lose the ability to do things like pick up a child, a bag of groceries - anything you might do with your arms pressing towards each other. Remember isometrics? (us girls used to do this as teenegers hoping to increase cup size :rolleyes:) Pressing your palms against eachother activates your pecs. Anything like that or even using arms away from the body... these are the movements you lose.

But you know, I felt tearing in my sternum before the pec minor surgery. :confused:

The arm pulling/tearing feeling has only started happening in the last year (2 years postop). I believe this is progressive, after 2 years of trying to cope on my own (with no help lifting things) my muscle groups are over taxed.

I hope the one surgery you had will be enough to carry you thru to some better quality of life. Maybe repeated pec minor blocks will be all you need to beat this thing!!

:hug:

Anne, when I had my right pec minor tendon detached, I experienced similar feelings of instabilty - for 8-10 months or so. I don't do a lot with that arm, which has RSD the worst, but I am now able to lift a gallon of milk and pour it, carry a small stack of books, open a door that isn't heavy, without major discomfort or a later flare. A heavy door, or carrying much weight for too long a time WILL flare me badly.

I wonder if the difference in our healing lies in a difference in where the tendon re-attached? I truly can't imagine having both scaps detached from the pec minor attachment at the same time - but I understand you had NO choice about timing. I am fairly sure though, sister Anne, that you and I were the guinea pigs for this surgery, and it has been further refined - such as Dr Sanders taking an inch of the tendon to prevent it reattaching. There simply was NO description of this procedure when we had ours done - because no Dr was doing it. Which I still don't understand, as all the literature TALKS about the pec minor being one of the points of compression!

And, in my case, and yours, the cords were severely damaged, leading to muscle atrophy in the hand. The pec minor compression at the axilla is the cause of that TERRIBLE pain that feels as though someone's been jabbing a broomstick handle into your armpit 24/7! That disappeared thankfully immediately post-op!

There seems to me there still should be a better way to make additional room for the nerve cords and/or vein/artery, rather than taking away a muscle attachment and asking the body to adapt, especially in an already compromised area. What about inserting very small thin saline pillows near the nerves, BELOW the pec minor, just to lift the muscle a tiny bit in the needed area? We know hyperbaric oxygen has worked well for some TOSers, I believe the rich oxygen helps eliminate the on-going inflammation that causes irritation and swelling. But insurance won't cover HBOT for TOS, and it's not easily available in most parts of the country.

So for now, surgery for pec minor compression is probably the answer when PT fails - but, like with rib resection, only MORE so, I would URGE you to seek a top surgeon who has done several of them, who can anwer your questions and who has a post-op PT protocol.


beth

Hi sister Beth!!

Yes, if memory serves me correctly, we were the guinea pigs for this procedure. Which is why I believe it's important to share our experiences with other TOSsers as well as our beloved Surgeons.

I wanna be a VALUABLE guinea pig, not a discarded one. As time passes, sx can change or evolve. I had no idea the muscle could re-attach itself!! :eek: as far as I know mine were left 'floating' on the detached side. I'll go back and reread the op report.

So glad to know you acn lift a gallon of milk!! I'm having a hard time with 1/2 galons.

:grouphug:
Anne

Other names for Pec Minor Syndrome
 

I've been researching this a bit on the web and have found that there are a number of other names for pectoralis minor syndrome (or subcoracoid-pectoralis minor tendon syndrome), such as Hyperabduction Syndrome, and Wright's syndrome. I haven't found out a lot about treatment for it yet but it seems to predate TOS, at least according to this source:

http://www.medilexicon.com/medicaldi...ction+syndrome

So my question is, how were surgeons treating it prior to Dr. Sanders arrival on the scene? Was another surgical technique used? I will keep fishing and post what I find here...

A little more: I have been told that because TOS is made up of a constellation of structures (and therefore disorders) that can compress the neurovascular bundle (subclavicle arteries and veins and brachial plexus), any good TOS surgeon would know all about the possibility of impingement at the pec minor location. It seems that isn't always the case, or perhaps some TOS surgeons hope that by performing a scalenectomy and/or a first rib resection, the impingement will be lessened on the neurovascular bundle to the extent that the pec minor issue would become irrelevant. Of course, for that to be the case, the pec minor entrapment could not have been the major point of compression. Does that make sense to anyone? Anyone agree/disagree, or have other input?

Melissa

Dancing to the music of those fibrous bands!!!
 

I have a thought to add...as I asked many of these questions myself.

For most TOS'ers there are several "fibrous bands" and scar tissue that develop to help the compression along...both in the neck area and in the distal region closer to pec minor.

As a standard part of the 1st rib resection, at least as I was told by Dr Reil (Dr Ahn's junior partner), a surgeon will detach any obvious extra fibrous bands near the pec minor on their way to the first rib.

Some doctors approach it differently, and I think there is a fine line between too much disturbance and getting enough out. For instance, Dr Filler makes a huge production of "cleaning up the area" by freeing every nerve, surrounding it with his favorite brand of neurological saran wrap, and then putting everything back together. He even makes a second incision at the armpit when doing a supraclavicular scalenectomy w/o rib resection to clean up the area near Pec minor.

Dr Jordan told me that his opinion is that it is best to disturb as little as possible to avoid the production of extra scar tissue "get in and get out!", since most of us are prone to it anyhow *and* by disturbing things you can generate more scar tissue as the surgical areas heals. He often looks at post surgical scar tissue by ultrasound, so he has seen the results of many different surgeries. (and has told me very seriously that Dr Ahn's technique is "excellent!")

Dr Ahn's approach seems to be to get the obvious stuff, but not disturb any more than neccessary to get the job done. At least, that's what I got by talking to him...I guess it is difficult for any of us to really know. And time will tell if that was a good approach for me :)

Sharon Butler points to the Pec minor often as a culprit in RSI & TOS -due to sticky fascia and impingements there.

Hello everyone and thank you so much!!! Fern I did have my symphatic nerve cut and right now I think it is too early to say my outcome, I know it has been 2 years but with having TOS and CRPS and now this pec minor it is hard to tell.
First what I just learned from you all it helped exspalin my hand is it right than with the pec minor compressing nerve bundle it affects hand? my hand is swollen and off color, alot of pain like the RSD/CRPS burning stabbing and my wrinst bone feels like it is in a vice at times, not constant but off then on also cold hurts it.
Also anyone if you can help, so with scare tissue you all say it comes into play right? befor my TOS I had shoulder surgery a open mumford along with bone spurs and reshape my bone and a slight tear, now when having my TOS and symphatic nerve cut I had scar tissue cleaned from the shoulder surgery, I was told we hope that this may be the problem (pec minor) but if not than it could well be scar tissue than if it is the case it would more likely be a on going thing to clean up scar tissue for the rest of my life is it true?
I hope that is what causing it and not my RSD/CRPS hitting me harder and spreading I'm at a loss it is all so complex, one can mirror the other and well it just plain HURTS! Thanks everyone..

Tshadow thank you see that is what is going on the neck hurts like it's been whiplashed and stiffness in legs more on right side pain inbetween shoulder blades and right in the middle of my chest, my arm is swollen and hurts armpit is sensative still fingers are so swollen and fat along with hand, I cannot lay in bed breathing is hard I must lay in recliner. I have headachs mostly on the side of RSD and TOS operation above eye or behind eye the most that may be because of symphatic nerve cut? I got lucky no horners with how far they cut nerve, I may still get it though. I dont want to ask about Fibro yet is that my deep bone pain? it is nuts to exsplain but it feels like my bone is in a vice being squeezed my walking is getting worse my whole side of TOS and RSD just gets so flared up the muscles are so tight I cant walk I guess it is just normal for us than?
I feel I cant give in yet I must try to move my body more but I cant it bites me in the end, this sucks! I ask myself is it getting worse? I feel it is but I cant give up, this feeling I have is making it worse though I know I push too hard, one more step one more lifting arm up so on,and on is not right ughh sorry guys and gals just scared is all.
I really am scared of the needle touching my RSD side when they do the pec minor test since RSD I've had 2 needles stuck in RSD side by IC docs who hurt me bad, one was for testing dye for MRI and one was a doc who did not believe I hurt so he tried a general numbing shot and I had to held down because of the pain, I dont care if needle goes on unaffected side but MAN the pain it causes is GREAT.
Sorry I'll stop love ya all.

((((((Flippinout)))))))
:hug: