1st rib surgery question ?
 

Hello,

I'm still researching surgery and trying to determine what is best for me. I've have learned so much from this site. The different types of surgeries, different
options, doctors, therapy etc. I've also learned if someone with TOS waits too long and continues to aggravate thier body surgery may only give a smaller % than if someone who listened sooner........anyhoots here's my question.

If the nerves and the scalene muscles are severely smashed/compressed, so the doc says based on the MRA/MRI test and he wants to remove my 1st rib and the scalene muscle....why does he have to remove the scalene muscle too? isn't there going to be more room for the nerves and muscles if the rib is removed?......I know you guys can help me on this. I want your advice before I speak to my surgeon.

Thanks
Ann

in the same boat, i think....
 

Ann- I too have only been hanging around here for a short while. I've learned alot, and gotten great support from the people around here. I'm now in the same boat as you- at today's doctors visit (with the thoracic surgeon)- he mentioned that surgery was a possibility. Now, he did warn me that the outcome can be kinda like flipping a coin - it may or may not work. He had a patient who opted for surgery - 2 weeks post-op she thought Doc was the greatest thing since sliced bread - no pain, felt great, etc. 6mo later, she was back to see him with pain levels as bad as ever. We decided that for right now, we will continue the PT/streching/medication route, since i've seen some "improvement." Also - he really liked what I'd said about this forum:cool: He also lamented the fact that relatively little is STILL known about TOS and RSD. The conclusion that i've reached may be different than the one you reach - i think it boils down to what has or hasn't worked, how you feel, and a slew of other personal factors. Heres to hoping ya'll have a low pain night.

I really believe that people who get TOS from a traumatic injury would benefit better from surgery right away. I got mine from a car accident and went through Feldenkrais, PT, acupuncture, facet joint injections, shoulder surgery, and anything else that they could throw at me for almost two years before I had my surgery. I think that the longer things are compressed the more permanent the damage becomes. That's just my opinion. As far as the rib removal--the first TOS Doc I saw said that based on the scalene block he did, he would remove only the scalene if he didn't see evidence that the rib needed to be removed when he got inside. I ended up having another Doc do the surgery and he removed both....

Barnburn- are you much better now? Just curious. I too am trying to throw everything I can at my injury- I am partway thorugh a full course of hellerworking since PT didn't work. I also see chiro 3x a week. I am not sure how long to keep at it before I decide it isn't working. I don't expect any of it to go away overnight, so I am trying to stick it out for a fair time.

Johanna

Some Drs remove the scalenes, some don't, it's a matter of their philosophy.
Both the middle and anterior scalene attach to the first rib, so when they remove the first rib the scalenes have to be detached at that end. In my case the middle scalene was reattached, the end stitched down to soft tissue so that it would not attach to the brachial plexus in the future. The end of the anterior scalene was left free, I believe it is thought more likely to attach itself somewhere other than the brachial plexus.

Dr Annest prefers to leave the scalenes because they provide a smooth surface for the nerves to glide over. Plus, the more you cut, the more scar matter is formed.

It most likely depends on where the compression is located, and the cause. But with the anterior scalene left free, and the middle reattached higher up, the tension on them has been released, at least theoretically, unless scar matter entraps one or both or the anterior reattaches in the worst possible place. Those are variables the surgeon can't control.

They talk about the scalene triangle, but it is really more like an L lying on it's back. Think of the short end as coming down from the neck, and the long end as the area between the collarbone (top) and the first rib (bottom). Taking the rib out will free up space below the collar bone for the nerves, but it doesn't do much at all for problems in the neck area, other than releasing tension on the scalenes as I've mentioned. That may not always be enough if there has been significant neck trauma, especially if there is compression of a vein of artery involved. Do you know if that's the case?

Has your surgeon done quite a few of these surgeries? This is definitely a time when you want someone who does these routinely, not once or twice a year!

best wishes,
beth

Hello,

yes...he seems to be the only one in Nor Cal doing them right now. At our first meeting in Aug 2006 he had performed 70+. My problem is compressed nerves in between the 1st rib and clavicle..the right side is narrowed to 6mm causing tons of pressure and tons knots in the back, shoulder, neck yada yada...you know the story. I need to ask him if I'm in a postion to only have the 1st rib removed...It seems in the long run I would be better off for my neck since I already have had neck surgery ( double level w-nerve damage).
But who knows what the long term affect of TOS has had on my neck.......
Thanks for your reply...

Ann

Johanna;

I have some symptoms that have gotten better--and some that haven't. I have had a re-do surgery since my original surgery. During the second surgery they removed my middle scalene as it had decided to attatch itself to my brachial plexus which caused severe pain down my arm when I chew, cough, sneeze, etc. Unfortunately, that didn't remedy the problem either. Everyone has different symptoms and everyone responds differently to the various treatments offered. I am glad I had the surgeries as I know that I have done everything possible to get better!

After my surgery, I cannot see or feel the removal of the rib or muscle(s). It looks and feels just like my left. Just FYI.

Hi All,

I just had surgery last week and had the anterior scalene removed and part of the muscle. I have my post op report and it reads that I damaged the muscles somhow and as scar tissue built up it encased the muscle along with the nerves. So they removed only the scar tissue, one muscle and a fibrous band. They unstuck the nerves and was very careful to test each nerve diagnostically during surgery to determine its' health.

I looked at both options, rib removal froma vascular surgeon and this surgery from a neurosurgeon. I felt more comforatbale with the neuro since the nerve were the major problem, not vascular.

So far so good. Glad to be back.

Happy Holidays.
Shelley

Shelley are you doing well post op?
How long is the recovery period for your type of procedure?