Pec Minor bits and pieces
 

When I went looking for info on a surgey for pec minor compression in August 2004, there was NOTHING to be found on the net - cause they weren't being done, not for nerve problems or chronic pain due to nerve problems anyway.
That October Sistah Anne and I were the first to offer up our pec minor tendons in the hope of pain relief, and since then it seems the good Drs have "discovered" a lot of us TOSers have this problem - uh, what took you so long, Docs?? I really find this SO curious!!

Anyway, there is beginning to be some info out there, and since it often goes with TOS, it makes sense to gather info and sites relating to pec minor syndrome and tenotomy as well. Please post any you find to this thread for the ease of those seeking to learn more about this subject.

This first bit is from Dr Sanders website; I'm really encouraged by the # of people whose pain improved enough from the fairly easy pec minor surgery that they elected not to have the rib resection. I don't think that wd have worked out in my situation, but it wd have been nice to have the option of going with the easy option first to find out! Here's Dr Sanders:

In 2005 we became acquainted with a condition that was described 60 years ago but which most of us had ignored, the pectoralis minor syndrome (described above under "cause" and "diagnosis"). Each patient we now see for TOS is also examined for this. We have been surprised to find that at least half the people who have TOS also have complaints and positive physical exam findings of pectoralis minor syndrome. If following a pectoralis minor block there is significant improvement within a few minutes, we have been performing a very simple operation called pectoralis minor tenotomy. This operation is performed through a 3 inch incision in the arm pit. The pectoralis minor muscle is easily found and cut at its attachment to the shoulder blade (at the coracoid process). One inch of the muscle is then removed to prevent it's reattachment to the top of the nerves going to the arm. The incision is closed with buried stitches. The operation usually takes less than 30 minutes and can be performed as an outpatient and recently we have found that this procedure can be performed under local anesthesia, but with an anesthesiologist in attendance so that patients are asleep for a short time but are awake within a few minutes of the end of the operation. The procedure carries almost no risk of injury.

In 2005 and 2006, we performed 130 pectoralis minor tenotomies as the only operation. 60 of these were performed in patients who previously had been operated upon by scalenectomy or first rib resection. They had experienced partial improvement in their symptoms from their operation but continued to complain of pain in the chest and pain over the shoulder blade.

Separately, 70 pectoralis tenotomies have been performed on patients who had not been operated upon previously. They had been seen because it was thought they had TOS. On exam, most of them did indeed have TOS, but also had findings of pectoralis minor syndrome. When their symptoms and findings on physical exam were dramatically improved by a pectoralis minor block, they were offered the simple operation of pectoralis minor tenotomy with the understanding that if they did not experience good relief of their symptoms they could return for the bigger operation of scalenectomy or first rib resection. To date, 6 patients have returned and received scalenectomies. The other 64 have had enough improvement that consideration of additional surgery has not been necessary.

Results of Treatment

Most people with TOS will improve with stretching and physical therapy. In our experience with over 5000 people with TOS, less than 30% had surgery. The improvement rate with surgery varies with the cause of the TOS. Auto injuries have a success rate of about 80% while repetitive stress at work has a success rate of 65-70%. Pectoralis minor tenotomy has only been performed for the past two years. The success rate to date is over 80%.

Pec Minor illustration
 

Link to a good pec minor illustration - the site and text is in Dutch though!
Mark, can you sprecken ze Dutch?? LOL!! :D

http://www.rsi-therapie.nl/pect__minor_syndroom.html

Beth wonderful post. I made some links in the RSI forum sticky on here. I hope maybe someone can move them here. I forgot how I did it.

I made a "pec minor syndrome and tenotomy" post in the useful stickys and put a link to this thread there.

http://www.vascularweb.org/_CONTRIBU...s/Cassada.html ......Beth, I remembered this very interesting David Cassada report from 2004.

"Dr Johansen’s operative approach to brachial plexus relief involved a standard supraclavicular approach with anterior scalene muscle resection brachial plexus neurolysis and segmental first rib resection12. He also advocated the addition of the release of the pectoralis minor muscle to divest the cords of the brachial plexus as they pass under the corocoid process, a second sight of nerve compression associated historically with the upper extremity “hyperabduction syndrome.” His experience with this technique was first developed as an adjunct to reoperation for TOS and he has now selectively incorporated it as a part of the primary operation for neurogenic TOS. His is currently collecting outcomes data relating to this combination therapy."

More Pec Minor Links
 

I hope these links work.

http://www.cartage.org.lb/en/themes/...alisminor.html

http://deeptissue.com/articles/pecminor.html

http://www.nismat.org/ptcor/thoracic_outlet

http://www.ncbi.nlm.nih.gov/sites/en...ubmed_RVDocSum

http://www.getbodysmart.com/ap/muscu.../tutorial.html

I might add that Dr brantigan told me verbally that though Johansson hasn't published it yet, he has stopped doing pec minor tenotomies.

I don't kow how true this is, and I think it was one of many points of contention between sanders and brantigan. Just a thought.

Paper: "Recurrent neurogenic thoracic outlet syndrome." Pec minor tenotomy performed.
 

http://www.ncbi.nlm.nih.gov/sites/en..._uids=15041500

Moderators, I'm not sure if I can post this, but since it's just the the stuff from pubmed, not the actual paper, I thought I might be able to. If not, please delete but leave the link and paper name/authors. Thanks!

1: Am J Surg. 2004 Apr;187(4):505-10. Links
Comment in:
Am J Surg. 2005 Jul;190(1):156.
Recurrent neurogenic thoracic outlet syndrome.Ambrad-Chalela E, Thomas GI, Johansen KH.
Vascular Institute of the Northwest, 1600 E. Jefferson St., No. 101, Seattle, WA 98122, USA. kaj.johansen@swedish.org

BACKGROUND: Although 90% of patients with neurogenic thoracic outlet syndrome (NTOS) experience "excellent" or "good" results after thoracic outlet decompression, recurrent symptoms may develop in certain patients. METHODS: This is a retrospective review of patients with NTOS who developed recurrent symptoms of upper extremity/shoulder/neck pain, weakness and limitation of motion at least 3 months after initial relief of symptoms by surgical decompression. Diagnostic procedures and outcomes of reoperative surgery were assessed. RESULTS: Among almost 500 patients undergoing initial successful thoracic outlet decompression for symptoms of NTOS during the last decade, 17 redeveloped classic NTOS symptoms (3 of them bilaterally) at intervals from 3 to 80 months (mean 18 months) after the initial operative procedure. Ultimate diagnoses included incomplete first-rib resection (n = 1), compression of the brachial plexus by an ectopic band (n = 1), persistent brachial plexus compression by an intact first (n = 2) or second (n = 1) rib, brachial plexus compression by the pectoralis minor tendon (n = 13) and adherent residual scalene muscle (n = 14). Anterior scalene muscle block was positive in 9 patients later found to have recurrent symptoms from adherent residual scalene muscle. Among these 20 cases of osseous or musculotendinous causes of recurrent NTOS, all had "excellent" or "good" results from repeat surgery to eliminate the underlying structural problem (removal of intact or residual rib, pectoralis minor tenotomy, brachial plexus neurolysis, or a combination of these). CONCLUSIONS: Complete excision of cervical or first ribs and subtotal excision (instead of simple division) of the scalene muscles will decrease the incidence of recurrent NTOS. Pectoralis minor tenotomy should be considered part of complete thoracic outlet decompression. Anterior scalene muscle block accurately predicts outcome of reoperation for certain types of recurrent NTOS.

PMID: 15041500 [PubMed - indexed for MEDLINE]