That's great that your problems were so easily visualized and explained and the Dr. could correct the problem. Hope your surgery is a great success.

I'm impressed with his use of the arthroscopic camera. Hope you continue to improve quickly!

Mini-milestone: I was able to shower without assistance before bed tonight. I just hope the progress continues when I stop the Toradol.

That's great, Marc! It's funny how much you appreciate little improvements like that, isn't it? Are you catching up on any bad television or movies? I had a hard time staying focused long enough to keep the characters straight the first few days in the hospital.

hi nospam, this may seem like a silly question but do you think anything in particular gave you the scar tissue? i always associate it with accidents and operations

the camera does sound awesome

My theory is that my brachial plexus has been rubbing across the 1st rib for years, forming the scar tissue and eventually fusing to the rib. I think the root of all of this with me is rib subluxations and nothing to do with my scalenes (which is why the scalene block didn't work).

My left side is improving rapidly. I'm typing with both hands right now and I think I will be able to drive by Thursday (just one week after surgery). I think I will be ready to return to PT with Dr. Ando next week (I follow up with Dr. Angle on Monday).

I'm going to have the right 1st rib resected soon (in May I hope), then I will continue therapy with Dr. Ando to fix my remaining ribs.

I've been off of Toradol and moved over to Celebrex for over 24 hours now without any change in progress. I'm hoping to reduce the amount of Norco I'm taking further once I see Dr. Angle on Monday. I'm down to 3 times a day from 4 at the moment.

Marc, if the anterior scalene's only job is to hold up the first rib, will it just be left hanging now? I'm glad to hear you're doing so well!

My understanding is that when the "UCLA" version of the transaxillary rib resection is performed the anterior and middle scalenes are only partially resected from the 1st rib (I've seen it referred to as a 25% scalenectomy), the subclavious is resected from the rib as well. The expectation is that these muscles atrophy and retract and do not cause future problems. I guess they are just left hanging.

The TOS info sheet Dr. Gelabert at UCLA gave me states that 10-20% of patients experience recurrence of symptoms and require supraclavicular full scalenectomy years later. Dr. Angle told me that making sure the rib is removed as fully as possible (no stubs), the chances for recurrence go down. He said he's only had one patient need the second surgery so far (I'm sure Gelabert and Ahn have been doing this much longer than Angle as he trained under them). The fact that I did not have scalene hypertrophy combined with Dr. Angle's addition of the arthroscopic camera leads me to believe my chances for this recurrence is very slim. Dr. Angle also stated that I now have plenty of space in in the outlet/inlet now.

If you want rib resection and/or full scalenectomy, the UCLA trained surgeons still remove the rib transaxillary and the scalenes supraclavicularly. I believe they feel there is less manipulation of tissue (especially the brachial plexus itself) when removing the rib transaxillary if my memory serves me correctly. I don't think they recommend doing the rib and the full scalenes the same day (I think Dr. Ahn may do it if you insist). I think the advantage of the fully supraclavicular approach is that you get the both the rib and the scalenes in one procedure vs two, but I think they have to move the brachial plexus around more and you still end up with two incisions. Someone please correct me if I am misinformed.

I firmly believe that the best approach each individual is the one your surgeon is experienced/comfortable with. I'm sure there are pros and cons to each.

Dr. Angle told me I was the first patient he has used this technique with. The goal was to reduce tissue manipulation and improve my recovery time, which I believe has been achieved thus far. He promised me that there was no risk. If it didn't work as he predicted my recovery would be the same as the standard surgery without the camera.

Many thanks to Kerryucialumni, otherwise I would have never found Dr. Angle in the first place!