Hey there. This is my first post though I have read many threads over the years. Short background on me - I was diagnosed with TOS in September 2008 after 10 years of worsening chronic pain. I had a first rib re-section by Dr. Hugh Gelabert at UCLA in April 2009. I recovered and was essentially symptom free with occassional mild flare-ups for 3.5 years. Then November came.

My symptoms have returned. I tried working through it for 3 months but finally went on disability in February. I have done almost 2 months of PT with little improvement of symptoms. Scalene block helped a little but not enough (same as 4 years ago). Botox seems like a temporary fix and not worth it for me. I am having a new SSEP done Monday and Dr. Gelabert is leaning toward surgery again - a full scalenectomy and removal of any scar tissue that might be there.

Has anyone else had a recurrence of symptoms years later and then surgery again?

I REALLY don't want to go through another surgery, especially as this seems more invasive (the first was underarm) but I am not sure what else to do. I am also very limited because this is going through WC and they don't love throwing you money for various doctors, physical therapists, etc.

I am in the same boat as you. I saw Dr. Gelabert a year ago but had surgery with one of his former fellows, Niren Angle. Dr. Gelabert gave me an info sheet explaining that the transaxillary procedure was less invasive but had a 10-20% risk of recurrence and possible resurgery like you describe.

I also feel like the Botox is a temporary solution and we are in the process of scheduling supraclavicular full scalenectomy and neurolysis. I don't believe the supraclavicular scalenectomy is more invasive once the rib has already been removed. It should be actually be an easier procedure than either rib resection approach which is why Gelabert and disciples prefer the transaxillary approach even with the potential additional surgery.

Hi I am sorry your symptoms are back. I saw Dr. Gelabart for a consultation last year. I liked him alot and if I were to do surgery- I would go back and see him. What were your experiences with him besides the pain coming back? Are you in the L.A. area? Thanks JKL

Thanks for the response Marc. What you say makes sense about the supraclavicular without the rib issue. I hadn't thought of that. Has Dr. Gelabert brought up the possiblity of Pec Minor Syndrome? The more I read about it, the more I think it is something else I need to investigate but Dr. G never even mentioned it. I am a little surprised by that. Either way, I see him again on the 17th and will bring it up then. Let me know when you schedule your surgery and how it goes.

Hey JKL -
Yes, I live in Los Angeles. It's great to have such great doctors in close proximity. Overall, I really liked Dr. G. He is good about answering questions, giving information, etc. and he has spent more time with me than most doctors will. His assistant (though she is out on leave right now) is great about following up on prescriptions, tests, blocks and easy to get a hold of. As I posted to Marc in the prior thread, he hasn't brought up Pec Minor Syndrome which is surprising to me but otherwise I can't think of anything bad to say about him. Good luck!

it seems like only a few dr's are doing this. Dr Sanders and now Annest has been doing it the longest and now Dr Thompson came out with a new study about it. I think dr Ahn does it but only after he gives you the angiogram/angiplasty test. I think it will get more common now but it is still a subspecialty. I think it is still a pretty controversial diagnosis. good luck and let me know-
julia

I asked Dr. Gelabert about pec minor as I had a lot of pain and tension here. If I recall, Dr. G said if he sees something obvious he cleans it up during the transaxillary procedure but does not perform the tenotomy procedure. I asked Dr. Ando about it and he felt that pec minor can be dealt with in therapy and should never require surgery. After going through therapy with Dr. Ando and Spousa, I lean their way that pec minor should be dealt with in therapy.

That being said, everyone doesn't have access to the same therapists or are as diligent with therapy and home maintenance exercise as others.

Do you have a link?

Thanks for the info. I am trying to get my WC to cover Joyce Wilkinson if possible. I need to find a PT that has done A LOT of TOS work and knows it really well. If I can do that I will talk to her about Pec Minor Syndrome. I have been stretching my pecs, focusing on the minor, daily.

I'm not even sure that mine are pec minor issues because it feels more like the teres major and minor and subscalpularis?- all around my under arms. The pt didnt really help me with this and is the most stubborn to resolve.
When I see Dr. J next I am going to ask if he can do a pec minor block?

I will look for the atrticles and post them here-there are 2.