Nerve Block Injection - TOS
 

Hi,

I've got a consultation tomorrow with a specialist, and was wondering if anyone with TOS has had a nerve block injection? i've previously had partial 1st rib resection. I still have pain in my shoulder, and my entire right arm is numb, becomes discoloured. have had MONTHS of physio, acupuncture, even steroid injection (the only thing that worked was having the needle getting stuck in my shoulder from spasms) you name it! still do excerises at home. the only thing that somewhat works right now is heat, and pain meds (which I HATE taking)

Has any had a nerve block injection? any other recommendations? Just don't know what else to do.

Thanks,

Partial rib resection?
They didn't take the whole rib?? :confused:
Does that mean they left a stump or portion of the rib?

I think most surgeons take the whole rib now, because the stump left behind can cause rubbing, scarring, irritations or other issues.

In the past, quite a few usually with nerve TOS (NTOS) posted about various injections. Usually Marcaine, Novocaine or combos and even botox..
You can use the search link in my siggy to find some of those posts.

Thanks, for your response.

yes he only took out part of the rib, that was putting the pressure on inflamed nerves within brachial plexus, there were alot of scar tissue removed aswell. I did ask why he didn't remove the entire rib, if there was scar tissue, couldn't and wouldn't that cause more problems in the end if there was only a stump left (like you mentioned additional rubbing, more scarring, irritation). i'll ask one of my other drs - who i see in 2 weeks to review the OR report and see if there is any mention as to why it was only partial removal). Either way. i've had some post-op testing (MRI, XRays, U/S). - says everything is normal. even though, i still have 95% of the same symptoms)

I saw the specialist today, and i'm going to try to see if this helps. he does't think it will, however two other specialists I've seen think it might (one being a neurophysiologist and another neurologist). who knows. can't hurt to try.... now the waiting game for the date...

Thanks again :)

your symptoms sound just like mine. Please let us know how everything works out good or bad.

I am thinking about trying one of the posture control shirts, but I hesitant to spend a lot of money on something that might or might not work.

I guess as the pain keeps getting worse, I will spend any amount of money to stop it.

Hi moltra,

I will defiantly let you know how it goes. still waiting for a date for the procedure (they say it might be done in June/July) depending on the scheduling in the hospital.

I purchased one of those posture braces, but wasn't overly keen on it, it put more pressure on my shoulder. you could always, buy a very basic one on eBay and see how it works, and they're not overly expensive to just give it a shot. Fingers cross it helps!

I know exactly what you mean your willing to do anything to try and relieve the pain. the dr who is doing the injection, I don't think realized what TOS is... and why i asked to even try it. I was extremely apprehensive to try it, but, it's only costing me a day off work (i hope thats all). but i'm willing to try anything at this point...

if you decide to get a posture control shirt, let me know how it works. i'd be interested to see.

Nerve Block
 

Whoa, Friend! This sounds risky to me, esp. if your doc is unfamiliar with TOS, as you say.

What nerve(s) are to be targeted? If you're talking about the brachial plexus and the phrenic nerve, or other inter scalene placement, please make absolutely sure they are going to use imaging by ultrasound, fluoroscopy (live x-ray) and/or CT scan to guide the physician in needle placement.

Will you be awake during the procedure, so that electrical stimulation can be used to provide feedback on the proximity of the needle to the target nerve(s)?

What kind of pain relief are you supposed to get from the nerve block(s)? How long will it (relief) last? I'm sure you have been advised of the dangers of permanent nerve injury involved with this procedure.

Also, what substance(s) will be injected (e.g., wydase, lidocaine, opioid, etc.). I know that Dr. Jordan used to do Wydase blocks of the brachial plexus (may still offer that, I'm just not sure)… but it makes me nervous - no pun intended! - that this seems to be so rarely performed, if at all, for TOS.

The blocks you will see discussed on this forum are all muscle blocks, as far as I can tell. Scalene, subclavius, pec minor, usually - the so-called "culprit" muscles in the TOS monster we all struggle with.

I know what you mean when you say you will do anything if it will address some of the pain and other issues your TOS is giving you. You've had a first rib resection; the next surgery (called a "re-do") is usually a complete scalenectomy. Have you had that? Lysis and neurolysis are typically performed at that time, as well as general clean-up of any scar tissue that has formed around the brachial plexus, the subclavian vein and the subclavian artery and environs. The anterior and middle scalene muscles are taken out completely, along with any remaining portion of the first rib (if it wasn't completely removed in the first op it can grow back!)

Certainly don't want to scare you, but when you said the anesthesiologist (I think) did not seem to know too much about TOS - and, did not even believe that nerve block(s) are going to help you… Well, I just had to jump in.

The risk/reward ratio maybe needs to be looked at a bit more closely before you go forward with this. I know we have others from Toronto on this board; maybe do a forum search and see if some of them mention the particular vascular surgeons, pain management specialists, neurologists, PT's, etc. they have found who are knowledgable about TOS, and then book one (or more) for a second opinion.

Just my 2 cents! I wish you the very best in your quest for relief and hope you can get some "sustainable results," as they say. If I were you, I would proceed with great caution here. Our poor nerves don't like to be poked!

My 2 cents
 

Hey there!

Please get answers to the questions above if you don't already have them because that is risky. I had a nerve block but before I found out I had TOS and for my medial branch nerves in my neck (very small nerves). Obviously that never helped especially since I had been misdiagnosed at the time,
I am from Toronto originally and before I even considered Drs in the States, I did a search and made calls in Toronto. I even saw a team of vascular surgeons at Toronto General. They don't know anything! Well they def do not know enough that can be said for sure. If I know more than the Dr does, that Dr is not coming near me. Try the same approach. Honestly, I have done tons of research and very few not just Toronto but Canadian Drs know much about TOS and that is probably why your surgeon did not remove your entire rib in the first place. Be very cautious about this next step...

No, It was just a comment that 1 of the anesthesiologists' made, and i don't think he realized the significance of my TOS. I wasn’t impressed with the the original anesthesiologist and I requested a consult someone else, and asked if he even knew anything about TOS and specific blocks to the area where I need it, and my history with unsuccessful surgery, symptoms etc, and he actually was able to get my referring Dr and do a consult in the room - to make sure all my questions/concerns were answered (suffice to say the 1st guy isn’t coming anywhere near me). I’m also more comfortable to say that he has done several blocks for patients with TOS.

Yes. it's the brachial plexus and phrenic nerve, using the ultrasound.

I will be awake, they're just slightly sedating me,

they mentioned the injections are sometimes in series of 6. They want to try me off with just 1 injection (for now), and see if it works, and if it's worth doing again. They’re going to use bupivicaine (?sp). in terms of how long it lasts… the dr said it depends, it can last anywhere from a couple weeks to a couple of months. we just have to “wait and see” after the first set of injections.

"re-do" surgery is my VERY last option, and here they more than likely won't do it because i have "pain". unless they see issues effecting on my vascular system (which recent scans showed "none") than again, they can't see scar tissue... and honestly.... i'd be even more hesitant to have it done....

Thanks again

I haven't seen any of the vascular surgeons or specialists in Toronto General.... my surgeon was Dr DePerot Thoracic Surgeon (at Toronto General). But your right noone really knows much about TOS here. The block is being done at Toronto Western hospital. I swear i'd LOVE IT if my private insurance would cover a consult with "Dr. Donahue".

Do you have TOS under control?

Is your surgeon the one following that 1 surgeon that apparently was the only one who did TOS surgeries in Toronto? I cannot recall his name right now.

Anyway, I was lucky with Dr. Donahue and access to US surgeons because I lived and worked there for several years. I do not unfortunately have my TOS under control, Dr. D said I am one of the worst he has ever seen and he has seen A LOT. I am technically still recovering from my re-do and it did help but not enough for me to return to work or a normal life. I believe the seroma (complication) I got has a lot to do with the remaining pain in my arm and hand, so I am finally getting rid of that next week, but paying out of pocket for this surgery with Dr. D. I do not trust any other surgeon. Even though this is a smaller surgery. I did give it a chance, trying to get referred to someone here, but they said 6 to 12 month wait. No way I can wait that long, the surgeon I wanted to see obviously did not go over my notes properly to realize how severe my TOS is.
By the way, Dr. D has someone who has scans that show things like scar tissue, one more thing showing how much more advanced healthcare is there. I wish Cdn Drs would catch up already or at least keep up with the current research and new tests etc developed in the US.

Anyway, if you go through with this, good luck and keep us posted!