Hello,

Some of you have seen me post in the past....I'm still stuck trying figure out what to do. The MRV/MRAMRI showed a narrowing of 6mm in between my 1st and my clavicle and that's why the surgeon said he wanted me to do surgery asap...I live in the S.F. Bay Area and was lucky enough to speak with Dr. Sanders in Denver who's doing a Pec surgerys ( read his website) he's had lots of success in last 2 years for people who have needed surgery but opted for this 30min out patient surgery.....But how does this surgery help with the narrowing and relieve the pressure?

Who's had this prodcedure instead of the 1st rib removal?

Thanks
Ann

Hello,

Some of you have seen me post in the past....I'm still stuck trying figure out what to do. The MRV/MRAMRI showed a narrowing of 6mm in between my 1st and my clavicle and that's why the surgeon said he wanted me to do surgery asap...I live in the S.F. Bay Area and was lucky enough to speak with Dr. Sanders in Denver who's doing a Pec surgerys ( read his website) he's had lots of success in last 2 years for people who have needed surgery but opted for this 30min out patient surgery.....But how does this surgery help with the narrowing and relieve the pressure?

Who's had this prodcedure instead of the 1st rib removal?

I did see some from Wylie on 1.04.07 but it dosen't seem as common as Dr. Sanders made it sound.....

Thanks
Ann

ann-
the pec minor attaches to some of your lower ribs, and, if shortened, will pull the rib cage up, causing comlrpession at teh 1st rib adn clavicle. Also, and I think this is Sanders' thinking, much of the same nerve bundle passes between the pec minor and the ribs as through the brachial plexus.
That is what her refers to as the psctoralis minor syndrome, I believe.

I think this procedure can have some long temr consequences on your ability to lift things...like kids. I know at least one person has had it that I have seen, I'll search for the thread.

johanna

Anne... I was out to see him last April and still waiting for work comp to come through for me !!! on my left side hehas to fo the scalene, 1st rib, a snip or two or the trapezious and the pectoral, he says if he can catch me befor the right gets to much worse will get by with the scalene and pectoral minor... what it does from the way he explaied it, it opens the muscle in the shoulder just enough to allow freeing of the nerves and yes in some cases that is all he has done on patients with an excellent recovery rate ! He told me at times less can do more good with less harm. Just this idea of thinkinig helped place my trust in him, instaed of just getting in there and doing more cutting than needed! Though each case is different and guess his overall evaluation(which I must say was very thorough) is the decideing factor.. best luck and do let me know how you make out !!!

Mark-n-Goober

Ann,
Have you already tried PT & body/posture work with advanced therapists, or a expert chiropractor that uses many PT modalities?

Do you get pinching feelings in your arm pits? swelling or puffiness?

The Edgelow program is a bodywork /therapy type of program - therapy , tools and training - I believe you can order the kit to learn at home - to stretch, relax, breathe properly and get the muscles loosened up and retrained.
http://www.edgelow.com/

Sharon Butler has explanations of what and how the pec minor can cause problems & good stretches too
My favorite book = Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries- by Sharon Butler has very good stretches for all RSI /TOS with info on posture causes and corrections. She has detailed stretching ideas to gently coax the damaged tissues to release-not to force them. her website: www.selfcare4rsi.com

http://www.selfcare4rsi.com/thoracic...e-anatomy.html

I work with a number of physicians who treat patients with TOS, including several surgeons. I have observed Dr. Sanders evaluating patients for pec minor release, and have observed him perform one of these procedures, as well.

Although it is not known with certainty why a pec minor release would work in a patient with TOS, there are several theories:

1. The neurovascular bundle (nerves, artery, in vain) pass between the pectoralis minor muscle and the chest wall (the retropectoralis space). Theoretically, release of this muscle would widen this tunnel, and if compression is occurring here, would relieve the compression. However, most experts agree the impression that this site is somewhat unusual, and MRI studies have actually shown that this tunnel is wider in patients with TOS than in normal people.

2. A lot of the neck, chest, and shoulder pain associated with TOS is due to muscle imbalance and strain, and releasing this muscle can resolve some of those issues.

3. The above mentioned muscle imbalance can shift the position of the shoulder girdle, which is attached to the chest wall only through the clavicle (collarbone). Release of the pectoralis minor, which acts to pull the shoulder girdle forward and downwards, would allow the posterior muscles to shift the entire shoulder girdle backwards. Due to the complex shape and motion of the clavicle, this could serve to open up the costoclavicular interval (the space between the clavicle and the first rib). It is very unlikely that the position of the ribs would be altered.

At this time, it is unclear which patients would benefit from the pec minor release, and which ones require scalenectomies or resections of the first rib. However, the pec minor release is a minor procedure, and is certainly less invasive than the first rib resection and scalenectomy procedure used in most patients.

Regarding the nerve block, I have seen people perform it in different ways. Some people inject around the attachment of the pectoralis minor, which may anesthetize the nerves of the brachial plexus as they pass through this region. Other people inject directly into the muscle, which would tend to make the muscle relax and/or feel less pain internally.

I hope this additional information is somewhat helpful.

Thanks for all your info.....I just saw Peter Edgelow on Wednesday and he thought I should go for it.....I see Dr. Avery in the next month and now with all this info I can ask educated questions.....Dr. Sanders told me that Dr. Avery was in Denver observing with him a few months back, hopefully that means TOS's here in Calif may be able to get this procedure w/o going through that awful 1st rib surgey that we all know has no real promises....

Thanks again for all your time,
Ann

Annhere

I work with Dr. Avery, and we visited Dr. Sanders together to observe this procedure. To the best of my knowledge, Dr. Avery has performed a couple of these already.

A pectoralis minor nerve block may be available in the very near future.

I would respectfully disagree with the statement about the rib resection, as the local doctors have seen a good success rate following this procedure.

Best of luck moving forward

I had surgery in 04 where Dr. Sanders took 3 inches of muscle out under my armpit to help with the problems I have had.

It worked for me. I had chest pain constant for about 4 years and he was going to do the TOS surgery and when I went up we talked and opted for this surgery.

Now I only get chest pain if I do something to bring it on. I notice it once a week if I take the wrong meds, eat the wrong food or do something with my arm I shouldn't do.

It helped about 80%. At times I have thought about going ahead and having the whole TOS surgery but so far I haven't had to.

I spent the night in the hospital but it's because I have other medical problems that they thought might cause some problems.

I think it's the best thing I did though. I was so dreading the TOS surgery. It took me a year to heal from the right side surgery and I was just not looking forward to that. I'm glad I went the other route.

I will say also that Dr. Sanders is a very caring Dr. He calls me every once in awhile to check on me. I have been planning on emailing him to let him know that Bill passed away. He's been a good friend to me.

Ada
Ada

sawxray,

Oh my gosh am I glad to the news about Dr. Avery performing this procedure....when I last spoke w/Dr. Sanders he couldn't commmet. Thanks for the wonderful news....Sorry if touched a sore spot about the 1st rib surgery....it looks like your new to this site, so you mightt not have had a chance to read the many posts from others who have had the surgery, but still suffer. It seems the ones that do better are the patients who have had truama, not ongoing like me for 10+ years....but the again the ones who are better have moved on and we aren't hearing from them. I hope I can be like them.

Thanks for all your info. I was planning to ask you where you worked to see about an appointment....but it sounds like I'll be meeting you soon.

Ann