I am post op from scalenectomy/ partial removal of 1st and 2 nd ribs on left side x 6 weeks tomorrow. I only take 2 Aleve in AM and before bed for pain now. The more I get back to normal activities, I notice my left arm aching and my left hand getting discolored when it hangs down. Have others experienced this after surgery and how long does recovery take for most people? I am a pediatrician and want to return to work, but still need right side done. I am getting frustrated!

Cheri

How long did you have the sx before the surgery, and how severe were they?
Was your more vascular or neural TOS?

for the discoloring of the arm , what color does it go, blotchy, reddish, blueish...?

So they only took part of the top & 2nd rib??
Did they explain clearly why, was there anomalies causing compressions?

Usually they take the complete top rib and leave no stump to cause trouble later on.
Very few have the 2nd rib bothered with.

Or did you have the extra cervical ribs that can be above the 1st rib?

I think in general, the longer you have had the sx & pain pre surgery, the longer the recovery time. Mostly due to loss of muscle tone.
Vascular TOS pts usually recover faster, but if the nerves are involved they can take a long time to recover.


sorry for all the questions, but it helps us to answer your questions better.

Cheri, I am almost 5 weeks post op from full 1st rib removal and partial scalenectomy on left side. I think the fact that you are only taking Alleve for pain is a great sign. However, the hand discoloration worries me. I have read that partial rib removal increases chances of scarring vs. full rib removal and recurrence due to scarring can occur even in the first 3 months. I know you are a patient of the neurosurgeon Dr. Brown at UCSD, but would you consider a consult with the vascular surgery dept as you have vascular components to your TOS?

http://heartcenter.ucsd.edu/vascular/Pages/default.aspx

There is also Niren Angle (my doc) in Mission Viejo - www.niren-angle.com who was formerly the chief of vascular surgery at UCSD.

My neurosurgeon (I had a cervical fusion 13 months ago) advised me that surgical treatment for TOS is better left to the vascular surgeons in most cases.

Thank you for your input and questions.
A Thoracic surgeon was involved in the case as well and he often deals with vascular issues. Dr. Brown did a repeat CT with angiogram and showed plenty of space. I can get color back by raising my arm, but still achey.

For Jo*mar's questions- I had symptoms for almost 2 years before certain diagnosis. All symptoms started after repeat c-spine fusion done posteriorly 2 years ago, including 4 th and 5 th fingers curling up on both hands ( couldn't straighten on my own). After Scalenectomy, left hand now fully opens- yeah!

The color is initially blotchy, then progresses to blue/ purplish color if I don't raise it up over head frequently. The TOS is both neuro and vascular bilaterally. They removed only partial ribs of 1 st and 2 nd. I did not have congenital extra rib, but Dr Brown said my ribs are more vertical than he has ever seen before. I also had a branch of my subclavian artery that was in an unusual location and was clipped off. I guess my anatomy is a bit unusual.

I wonder if I should see a vascular surgeon before the right side is done next month. I love Dr Brown, but I realize the vascular issues that remain on the left may be something that I have to do something about.

It doesn't help that work urgently needs me back, but I have to have functional arms/ hands to do so.

Cheri

A second opinion can't hurt.

I agree, get more opinions , maybe independent of the drs you are seeing now, before moving forward with another surgery.
I think I would what more investigation & answers of why this is happening before tossing more $$ into the surgical pit.

Any suggestions of PT at all for this new thing before going forward?

There is a type of TOS that has compressions when shoulders drop down, and propping the arms in pockets, or on pillows when sitting- to take the downward pull off the BP helps..but it's not a permanent fix.

Chroma might recall the name for it , I know there was info in the useful stickys , but I can't recall the name/words to search for...

I had a year of PT before surgery- 3 different ones. Finally found a good one, but my symptoms didn't respond so surgery was necessary. I had tape on my back for posture, constant chin tucks, try to keep head on top of neck ( instead of forward). I will return to PT after other surgery since suppose to occur within the month. Dr Brown and I agreed that it would likely not be helpful to do formal PT then quit and restart after next surgery. I do some nerve glide exercises at home though.

Cheri

"Cyriax release test"

Search this PDF for "release":

http://www.watainc.org/uploads/pdfs/...to-loehrke.pdf