Nerve Damage from TOS or Rib Resection Surgery
 

Hi Everyone.

I was on the previous board and I was excited to see that I found some familiar signons. I have a question that I know everyone can give insight.

I had rib resection surgery 8/04. Since then, it's been a very long haul. My surgery was done under the arm - which I now hear is the wrong way to successfully complete the surgery. Anyway - I'm still having the problems with arm swelling, pain when the hand is down. I can actually control the blood flow in my arm. I put my hand up and it turns white. I put it down and within minutes you can watch it fill with blood and swell. I also still have portions under my arm that are dead from the surgery. So, here's my question...

I recently saw a Lymphedema Specialist and he said that I have nerve damage from the surgery or TOS in general. Because of the damage to the nerves they don't control the blood flow in my arm - hence swelling and pain. Has anyone else experienced this? What were your options?

Thank you for your help.

From what you describe it sounds like you still have a vascular compression somewhere. ??
Have you had a recent testing? MRA, doppler or veinogram?

So they only did the rib? did they leave a stump?
maybe they should look at the scalenes pinching the blood supply off?

Hi.

No, I don't have a stump from the surgery. They checked for that. I also had a venogram (which resulted in a blood clot and me being out of work for 2 weeks) but that showed a long vein narrowing in my arm - but both doctors didn't think that was causing the problem with the blood flow. There was also a minor compression by my clavical - which they also didn't think was a concern.

Hi, Have you had a Neurography?

How did you get TOS to begin with?

I came am up Neuro, Vasucular, with vein involvement. Hugs, Roz

Hi Again,
You are one of the few I can relate to on this site. I also have Lymphedema I was DX with that thru a CT. I will chat with you what I think could be going on with me. Hugs, Roz

Intuition
 

Dealing when you describe your symptoms it makes me think about an article out of Dr.Sanders book. I am not sure I would rule in or out the under arm approach, it is prevereance, but in doing os could they address the scalense area.

For example Dr Sanders notes the physiology of the vascular bundle travelling between the scalense insetead of a nromal route. So if the rib is resected and your body anomolie is that the vascular is still displaced and compressed.

Everyones bodies are different and not often normal, there can be short fibrous bands that hold up the neck area taht can spasms, there can be across teh traps a misplaces muscle sheathing, and also cervical ribs, or large collar bone.

I will search this article for Dr Sanders for you and see if it makes sense...sounds like you still have compression at another sight that freeing up with rib removal did not help much.

HERE IT IS"
Re-post on scalense and entrapment....

I have Dr.Sanders book here, I pulled up the chapter about the scalene triangle. Here is the information from the book,

Under a diagram it states: The scalene triangle contains the subclacian artery and the nerves of the brachial plexus. The subclavian vein lies anterior to the triangle
The diagram is from the jaw to the collar bone with the other structures in order from what appears to be towards the back as Middle sclene, then the nerves of the brachial plexus, next the anterior scalene.

Laying under them traveling under the collar bone above the first rib is the subclavian artery on the left and front is the subclavian vein.
...............................................
Then the section discribes the positions in medical terms.

Scalene traingle
This area is bounded by the anterior scalene muscle anteriorly, the middle scalene muscle posteriorly, and the first rib to its base. Any one of these three structures can cause compression of the neurovascular bundle and the clinical picture of TOS.

Anterior scalene
The anterior scalene muscle has a constant site of origin from the third through the sixth vertebrea, but its point of insertion, generally on the scalene tubercle of its instertion on the first rib, can vary.
The insertion of the tubercle is between the subclavian artery and vein, with the expansion of the plural dome. Variants include insertion behind the artery and brachial plexus, or an extended area of insertion behind the artery, between the artery and brachial plexus, or extended area of insertion that includes the entire base of the scalene triangle.

The latter variant may result in the anterior and middle scalene muscles forming a vise around the neurovascular bundle. The insertion of the anterior scalene muscle merges with the middle scalene muscle in 20% of individules. In half of all individules, the insertions are overlapping the first rib, while the other half of all individules they are joined in a common insrtion.


Deep into the anterior scalene muscle lie the subclavian artery and nerve trunks of the brachial plexus. Usually the nerves pass through a slit formed by the anterior and middle scalene muscles. IN some cases, howevere, the fifth and sixth cervical roots actually pass between bundles of the anterior scalene muscle rather than the hiatus between the anterior and middle scalene muscles. In one study this variant was seen in 45% of cadavers and 21% of TOS patients.

Middle scalene muscle
The middle scalene muscle originates from the transverse process of the second through the seventh vertebrae and inserts on the superior aspect of the first rib at "CHassaignac's Retroarterial tubercle." This insertion is broader and more posterior thatn that of the anterior scalense muscle. The middle scalene mucle may also have an expansion that inserts on the fibrous septum of the pleural dome.

Lateral fibrers of the middle scalene decend past the first rib to insert on the second rib. Insertion of the middle scalene muscle in a more forward or anterior position can cause copression of the middle trunks of the brachial plexus by contact with the sharp, anterior edge of the muscle. In a cadaver study published in 1948, the most frequently encountered anatomy was that of the lower trunk of the brachial plexus resting on the anterolaterial margin of the middle scalene muscle.

Fibromuscular bands along this border of the muscle may be one of the pathology mechanisms for TOS in the absence of a cervical rib. Among 33 patients treated for TOS by Thomas et al., middle scalene muscle abnormalities were observed in 58%.

Dear Dealing with TOS,

I am 7 weeks out of surgery (scalenectomy but no rib resection). I still have a alot of swelling and inflammation in and around the area which is causing pain. I have been on two rounds of steroids which help and bring the swelling down but once the pak was gone it would return.

And before the surgery, my PT work around the area on my neck and shoulders. And I would be like ouch is that the muscle...and she would say no that is your skin. I said what? She said that the skin isn't moving because the area was not moving well so the skin would get hard and the fluid trapped.

After the surgery I recently went to a new chiro who looked at the area and said that he thought maybe it was a touch of lymphadema in the area. He tried this new FDA approved lymphdema machine very gently onthe area and wow the swelling went down. I now do it twice a week and it helps.

So I do not think your concept is far fetched but maybe the lymph is damaged and needs some help. Maybe the nerve is damaged. Either way that fluid buildup is not healthy and giving it a little assistance might help it recover.

Good luck

Thank you for responding.

Buckwheat, I would be happy to talk with you. I'll send you a private message and I'll give you my e-mail.

Di Marie, I'm sorry, but my eyes just glaze over when I read this kind of stuff. I'm not a doctor, so I can't understand the specifics. Thanks though for sending it to me. It does sound like I have compressions, but the venogram didn't show one.

Shelley, when my doctor examined me, my arm wasn't hard at all. In fact, he mentioned that it wasn't hard at all... So, what is hard is that this is an atypical lymphedema case. So, he didn't think I had it. Now, when I hear of that machine, is it on the whole arm? Because I asked about a machine similar to what you have put on your legs during surgery that will expand and contract and move the blood/lymph.

They think the nerves are damaged... That would make sense. 1 Million Dollar Question: How long does it take to heal? Do damaged/severed nerves heal? I heard that it takes 1 year for nerves to grow 1 inch... I'm 2 1/2 years into this and it's still not better.

Hi Dealing.

My arm was not hard at all either but on my back around my shoulders it was. PT said it was because the area was wounded and the skin and tissue was not getting much movement so the lymph could not move the fliud out. Plus thinking like you suggested the nerves in that innervate that area were also hurt so maybe...you are right that the nerves being hurt distrupts teh circulation

I am guessing since arms move alot in general that they do not get hard like my shoulders but they get more swollen. Plus gravity does not help when arms are mostly at sides.

When I had surgery I had those things on my legs for 24 hours. Now this machine has a suction thing on the edn and he gently rubs it over the area to stimulate tissue movement etc. He does it for 10 minutes every other day and it atleast has helped the swelling and pain asscoaited with it. I am hoping that will help it heal better. I am just trying to help the swelling and inflammation to lessen any scar tissue development. Every little bit counts.

I will be happy to ask my doc what the name is and PM it to you.

Hi Again,
Please check you PM. I forgot to address the Lymphedema issue, so here I go.

I have had to be on several antibiotics, some even IV. The last thing I want to do is frighten you. But we are at risk for gangrene as well.

I had a severe infection down my arm. Also the last couple months I was Dx with cellulitis in my right eye. This was not in the eye ball itself but in the tissue. I am allergic to Penicillin which sucks. But I was given 3 antibiotics to take at once.

You need to make sure the Docs get to the root of the problem.

Hang in their. Hugs, Roz