Hi,

I've got a consultation tomorrow with a specialist, and was wondering if anyone with TOS has had a nerve block injection? i've previously had partial 1st rib resection. I still have pain in my shoulder, and my entire right arm is numb, becomes discoloured. have had MONTHS of physio, acupuncture, even steroid injection (the only thing that worked was having the needle getting stuck in my shoulder from spasms) you name it! still do excerises at home. the only thing that somewhat works right now is heat, and pain meds (which I HATE taking)

Has any had a nerve block injection? any other recommendations? Just don't know what else to do.

Thanks,

Partial rib resection?
They didn't take the whole rib??
Does that mean they left a stump or portion of the rib?

I think most surgeons take the whole rib now, because the stump left behind can cause rubbing, scarring, irritations or other issues.

In the past, quite a few usually with nerve TOS (NTOS) posted about various injections. Usually Marcaine, Novocaine or combos and even botox..
You can use the search link in my siggy to find some of those posts.

Thanks, for your response.

yes he only took out part of the rib, that was putting the pressure on inflamed nerves within brachial plexus, there were alot of scar tissue removed aswell. I did ask why he didn't remove the entire rib, if there was scar tissue, couldn't and wouldn't that cause more problems in the end if there was only a stump left (like you mentioned additional rubbing, more scarring, irritation). i'll ask one of my other drs - who i see in 2 weeks to review the OR report and see if there is any mention as to why it was only partial removal). Either way. i've had some post-op testing (MRI, XRays, U/S). - says everything is normal. even though, i still have 95% of the same symptoms)

I saw the specialist today, and i'm going to try to see if this helps. he does't think it will, however two other specialists I've seen think it might (one being a neurophysiologist and another neurologist). who knows. can't hurt to try.... now the waiting game for the date...

Thanks again

your symptoms sound just like mine. Please let us know how everything works out good or bad.

I am thinking about trying one of the posture control shirts, but I hesitant to spend a lot of money on something that might or might not work.

I guess as the pain keeps getting worse, I will spend any amount of money to stop it.

Hi moltra,

I will defiantly let you know how it goes. still waiting for a date for the procedure (they say it might be done in June/July) depending on the scheduling in the hospital.

I purchased one of those posture braces, but wasn't overly keen on it, it put more pressure on my shoulder. you could always, buy a very basic one on eBay and see how it works, and they're not overly expensive to just give it a shot. Fingers cross it helps!

I know exactly what you mean your willing to do anything to try and relieve the pain. the dr who is doing the injection, I don't think realized what TOS is... and why i asked to even try it. I was extremely apprehensive to try it, but, it's only costing me a day off work (i hope thats all). but i'm willing to try anything at this point...

if you decide to get a posture control shirt, let me know how it works. i'd be interested to see.

Whoa, Friend! This sounds risky to me, esp. if your doc is unfamiliar with TOS, as you say.

What nerve(s) are to be targeted? If you're talking about the brachial plexus and the phrenic nerve, or other inter scalene placement, please make absolutely sure they are going to use imaging by ultrasound, fluoroscopy (live x-ray) and/or CT scan to guide the physician in needle placement.

Will you be awake during the procedure, so that electrical stimulation can be used to provide feedback on the proximity of the needle to the target nerve(s)?

What kind of pain relief are you supposed to get from the nerve block(s)? How long will it (relief) last? I'm sure you have been advised of the dangers of permanent nerve injury involved with this procedure.

Also, what substance(s) will be injected (e.g., wydase, lidocaine, opioid, etc.). I know that Dr. Jordan used to do Wydase blocks of the brachial plexus (may still offer that, I'm just not sure)… but it makes me nervous - no pun intended! - that this seems to be so rarely performed, if at all, for TOS.

The blocks you will see discussed on this forum are all muscle blocks, as far as I can tell. Scalene, subclavius, pec minor, usually - the so-called "culprit" muscles in the TOS monster we all struggle with.

I know what you mean when you say you will do anything if it will address some of the pain and other issues your TOS is giving you. You've had a first rib resection; the next surgery (called a "re-do") is usually a complete scalenectomy. Have you had that? Lysis and neurolysis are typically performed at that time, as well as general clean-up of any scar tissue that has formed around the brachial plexus, the subclavian vein and the subclavian artery and environs. The anterior and middle scalene muscles are taken out completely, along with any remaining portion of the first rib (if it wasn't completely removed in the first op it can grow back!)

Certainly don't want to scare you, but when you said the anesthesiologist (I think) did not seem to know too much about TOS - and, did not even believe that nerve block(s) are going to help you… Well, I just had to jump in.

The risk/reward ratio maybe needs to be looked at a bit more closely before you go forward with this. I know we have others from Toronto on this board; maybe do a forum search and see if some of them mention the particular vascular surgeons, pain management specialists, neurologists, PT's, etc. they have found who are knowledgable about TOS, and then book one (or more) for a second opinion.

Just my 2 cents! I wish you the very best in your quest for relief and hope you can get some "sustainable results," as they say. If I were you, I would proceed with great caution here. Our poor nerves don't like to be poked!

thanks,

I just had the nerve block on tuesday (5th). So far the only changes i've noticed is in my shoulder joint kind of a pulsating painful feeling (like if your leg falls asleep). I still have the pain (no changes yet) I developed quite the migraine afterwards, ended up having to take the following day off work which I'm not overly impressed about.

I find out what the next steps are (if any). I see one of my specialists (neurophysioloigist) next week to see what she suggests. and my OTHER neurologist and anesthesologist follow-up is the end of next month. UGHHHHH!!!

I'm still highly considering of getting an opinion from Dr. Donahue.

question: how many sets of injections did others have? So far I'm only the 1, to see how it might work (like everyone says on the panel Dr's here in Toronto don't know what TOS is). I find out the end of next month if i may/may not get more if it's worth it....

Thanks again everyone