[kyoun1e]

Went back to Dr Michael Donahue at Mass General a couple weeks ago. Last we had left it prior to summer, he had told me that I had an elongated transverse process on C-7 per their special CT Scan, but considering that my symptoms were diminishing to see how it goes and checkin during the Fall. He had mentioned that if "I can't get over the hump" with my own stretching routine, we could look into the CT guided botox injection. I felt like I couldn't kick this thing so I went back to his office.

Dr Donahue then showed me the CT Scan and to my dismay he went on to show me that not only do I have an elongated transverse process, but I also have a cervial rib that has formed. Ugh! The dreaded extra rib.

So we're going down the path to explore the CT guided botox injection in the scalene muscles. He's indicated that many times this works for about 2/3's of his patients. That said, it's a pain in the neck to get the insurance company to approve, but it's in process anyways. I'm not in excruciating pain so it's not critical that I get it done asap.

Anyways, I'm a bit disturbed by this new finding. My situation came on two years ago when I suffered some kind of upper trap/shoulder injury. This, combined with me being in a wound up/tight state due to bodybuilding along with being way too internally rotated seemed to be the perfect breeding ground for TOS. The cervical rib must be the icing on the cake. Add all those variables to the rib and bam...radiating scap pain and pain down to the elbow.

Now, as Dr Donahue explains it, I lived a good 41 years of my life with a cervical rib and without any issue whatsoever. He also thinks that since my symptoms have gotten much better over the last few months due to my own stretching and strengthening work it's very possible that I'm in the process of unwinding this whole situation.

I guess the question I have to the group, especially those with cervical ribs is, once your TOS symptoms emerged, did you find a way to put those symptoms into dormancy? Or is it a situation that you just have to manage as best you can because once it's "out of the box" it's just out there for good?

What I fear is that this is a situation...without surgery...that's something I have to manage very carefully...forever...while dealing with pain here and there. And worse case, it's really inevitable that I have to get a rib resection. I'm 43 right now and in the best shape of my life. As each day/year goes by, I'd imagine that this situation deteriorates.

Anyways, any thoughts would be helpful.

Thanks.

KY

[mspennyloafer]

i don't have any good advice, sorry

but just wanted to comment that is terrifying that they can discover ribs, i thought it would be fairly obvious!

best of luck to you

[chroma]

I think it's very cool that your vascular surgeon is taking your recovery step by step with an emphasis on conservative approaches. It sounds like you're in good hands. I think you need to work with the process as it develops and not worry as much as you are.

As far as bodybuilding goes... I feel betrayed by exercises like dips, shrugs and push-ups that tighten up and compress the body. My new religion is therapeutic exercise and stretching.

I realize what you're really wanting to find out is what people with cervical ribs have experienced. I hope they chime in for you.

[Sheri_TOS]

Given that you have an anatomical reason for developing TOS, you may fare better with surgery but it's no guarantee.

Personally, when I went through this the first time around, I was pre-disposed to TOS due to the bony abnormality involving the 1st rib. It took an event to "excite" the TOS and it never calmed down. Once started, it continued downhill. The only relief I had in 21 months from the trigger event to surgery was the month after the botox shot. I had complete relief for 4 weeks and it was great! When it wore off, the TOS symptoms returned with a vengence. I opted for surgery and I'm glad I did. This doesn't mean you will have the same results.

I have TOS on the other side now and I have a cervical rib on that side. Lucky me to have two different anatomical reasons for being prone to TOS. Despite the good outcome I had on the right side, I'm hesitant to go the surgery route again. I don't feel like taking another gamble.

[kyoun1e]

Originally Posted by chroma

I

As far as bodybuilding goes... I feel betrayed by exercises like dips, shrugs and push-ups that tighten up and compress the body. My new religion is therapeutic exercise and stretching.

Chroma,

I hear you on dips. I'm convinced they helped trigger my initial injury.

What are you doing now in terms of exercise?

I've really picked up the pace despite my situation. I'm lifting pretty heavy and frequently. That said, I have noticed my ol' elbow pain starting to pick up again ever so slightly which tells me that the compression is increasing. Still, I'm talking about a pain level of maybe 1.5 on a scale of 1 to 10. Probably need to cool it.

KY

[kyoun1e]

Originally Posted by Sheri_TOS

Given that you have an anatomical reason for developing TOS, you may fare better with surgery but it's no guarantee.

Personally, when I went through this the first time around, I was pre-disposed to TOS due to the bony abnormality involving the 1st rib. It took an event to "excite" the TOS and it never calmed down. Once started, it continued downhill. The only relief I had in 21 months from the trigger event to surgery was the month after the botox shot. I had complete relief for 4 weeks and it was great! When it wore off, the TOS symptoms returned with a vengence. I opted for surgery and I'm glad I did. This doesn't mean you will have the same results.

I have TOS on the other side now and I have a cervical rib on that side. Lucky me to have two different anatomical reasons for being prone to TOS. Despite the good outcome I had on the right side, I'm hesitant to go the surgery route again. I don't feel like taking another gamble.

Right now, the level of pain doesn't warrant surgical intervention. It's manageable. That said, this recent cervical rib finding plus a recent slight pickup in pain has me concerned that I start heading in the wrong direction.

The botox shot, if approved, will be interesting. Dr Donahue explained that sometimes this is all that's needed to "break the cycle" of tightness. And as you say, maybe this cleans out the "excitement." I guess we'll see.

I actually have a similar bony abnormality on the left side, but it is far less pronounced. The cervical rib is smaller and doesn't extend too far.

KY

[chroma]

Originally Posted by kyoun1e

Chroma,

I hear you on dips. I'm convinced they helped trigger my initial injury.

What are you doing now in terms of exercise?

Well I have circulation issues, so I'm taking it really slow. My current routine:

-- Some very light weights with few reps. No dips or shrugs.

-- Qi gong, but with modifications as needed to work around my issues. Mostly avoiding raising the arms overhead too much and reducing the circumference of any arm circles.

-- "Postural" and "therapeutic" exercises that come from Egoscue, PT articles, and "Fixing You: Neck Pain & Headaches".

-- I finish up with some sitting meditation with the arms propped up, and then static back.

I usually feel pretty good after the above.

Overall, my arm symptoms are minimal and pain is way down. Dizziness remains a problem.

[ladylaura418]

Hi there,

Interesting to read this thread, as I'm currently under the care of Dr. Donohue at MGH as well. He's the fifth doctor I've seen in the area about this condition, and I'm really hoping his care can assist my symptoms.

I am waiting for news regarding my Botox injections. My CT, EMG, nerve conduction studies, and x-rays all came back normal. My vascular study showed definite lack of circulation, and my symptoms continue. Dr. Donohue hopes that the Botox may do the trick...we'll see.

I've been really pleased with his care thus far. I hope you are too!

[chroma]

Can either of you find out and share how much the CT guided botox injections cost?

[GaryA]

Originally Posted by kyoun1e

Went back to Dr Michael Donahue at Mass General a couple weeks ago. Last we had left it prior to summer, he had told me that I had an elongated transverse process on C-7 per their special CT Scan, but considering that my symptoms were diminishing to see how it goes and checkin during the Fall. He had mentioned that if "I can't get over the hump" with my own stretching routine, we could look into the CT guided botox injection. I felt like I couldn't kick this thing so I went back to his office.

Dr Donahue then showed me the CT Scan and to my dismay he went on to show me that not only do I have an elongated transverse process, but I also have a cervial rib that has formed. Ugh! The dreaded extra rib.

So we're going down the path to explore the CT guided botox injection in the scalene muscles. He's indicated that many times this works for about 2/3's of his patients. That said, it's a pain in the neck to get the insurance company to approve, but it's in process anyways. I'm not in excruciating pain so it's not critical that I get it done asap.

Anyways, I'm a bit disturbed by this new finding. My situation came on two years ago when I suffered some kind of upper trap/shoulder injury. This, combined with me being in a wound up/tight state due to bodybuilding along with being way too internally rotated seemed to be the perfect breeding ground for TOS. The cervical rib must be the icing on the cake. Add all those variables to the rib and bam...radiating scap pain and pain down to the elbow.

Now, as Dr Donahue explains it, I lived a good 41 years of my life with a cervical rib and without any issue whatsoever. He also thinks that since my symptoms have gotten much better over the last few months due to my own stretching and strengthening work it's very possible that I'm in the process of unwinding this whole situation.

I guess the question I have to the group, especially those with cervical ribs is, once your TOS symptoms emerged, did you find a way to put those symptoms into dormancy? Or is it a situation that you just have to manage as best you can because once it's "out of the box" it's just out there for good?

What I fear is that this is a situation...without surgery...that's something I have to manage very carefully...forever...while dealing with pain here and there. And worse case, it's really inevitable that I have to get a rib resection. I'm 43 right now and in the best shape of my life. As each day/year goes by, I'd imagine that this situation deteriorates.

Anyways, any thoughts would be helpful.

Thanks.

KY

Sounds as though you have an ethical doctor. Feel blessed--only 1 in about 500 or so have that extra rib. AS your doctor recommends, if it ain't broke, don't fix it. I' assuming that this extra rib has some fibers of anterior scalene attached to it. Scalenes lift those 1-2nd ribs so you can breathe through the upper part of your thorax, so this extra rib is just hanging around, no muscle to move it, I would think that it would have been noticed long before now.

The best treatment bar none for sporadic TOS is trigger point therapy during a massage therapy session. If it were caused by the rib, it would be always present, no let up. Since it comes and goes, IMO it is caused by TrPs in scalenes of the lateral neck, pectoralis minor of the chest, and occasionally by the corachobrachialis that arises from the same attachment as the pec minor and attaches to the medial side of the humerus, about halfway down the arm.
A good NMT (trigger point) practitioner can locate and release those trigger pints in about ten minutes.

I agree with your doctor: surgery should always be the very last resort, because the cure is often worse than the disorder. Ask my wife: she's had three back surgeries and is in much worse pain than the mild discomfort she sometimes felt before the first surgery.