I've not had surgery- I actually listened to that little voice in my head that said "WAIT!." that, and the thoracic surgeon i saw said it was pretty much 40/60 odds that it would make me better. I didn't care for those odds, and neither did he. I have been doing nerve blocks and trigger point injections since last October with mixed success. They have worked better over time, which is good. ANYWAYS- i would say to not rush into surgery.

Hello everyone,

I received my medical records from my visit at the University of Minnesota and though there is no mention of the cervical rib (I was under the impression I had one because the procedure code for my surgery was for resection of a cervical rib. Guess not), the Doppler ultrasound of my arteries and veins has made pretty freaked that I will have to have the surgery. Does anyone know anything about reading the results from the sort of ultrasound? I'm currently searching for research article to purchase off the Internet (http://www.jultrasoundmed.org/cgi/co...tract/20/7/795 ), and my surgeon is out of the country so I can't ask him.

Besides losing velocity completely at 180° bilaterally, my peak systolic velocity for my left arm vein were all really low except at the resting/starting position. My arteries were better on both arms, but both still lost complete velocity at 180° as well as had a couple of rebound effects, one where my arterial velocity went up to 172 cm a second at the 90° position.

Here, I will try to give you the results of my venous findings to see if anyone can clarify this for me:

Veneous Right upper extremity:

Innominate: 76 cm/sec
Subclavian med: 24 cm/sec
Subclavian mid: 33cm/sec
Subclavian mid at 90degrees: 172 cm/sec
Subclavian mid at 135 degrees: 63 cm/sec
Subclavian mid at 180 degrees: 80cm/sec

Veneous Left Upper Extremiy:

Innominate: 71 cm/sec
Subclavian med: 24 cm/sec
Subclavian mid at 90 degrees: 27 cm/sec
Subclavian mid at 135 degrees: 39 cm/sec
Subclavian mid at 180 degrees: 0 cm/sec

Thanks to my mom for typing that part out for me!

Does the left looks scary or is that just me? Plus the 172 cm/sec on my right arm at 90 degrees. Scary!

From what I've read in the literature, TOS from accidents have better results from surgery than repetitve strain injury cases. The results are also better if it's done sooner rather than later.

The type of therapy you have had is similar I had initially, and while it helped restore range of motion, reduced pain, and got me better enough to do active PT, my ability to do anything was quite limited. I improved alot with the right kind of active PT, the edgelow protoccol. You can get it online www.edgelow.com and there are some tips I posted a week ago on how to learn it without a PT.

You have some differences from my injury and I'm not a surgeon so I don't know if this will help, but it's something you can try while you are deciding.

Two important things I learned what that TOS will not heal if you don't do aerobic exercise (which you might have to work up to slowly) and you don't strength the longus colli muscle in your neck.

Melissa you might call and verify if there is a cervie rib or not- they may not have put it in the report or the other report/code may have an error??

I did get copies of my MRI films - just for the heck of it - it did cost $10 per page/film I believe - some newer places will put it on a CD for you - my hosp didn't have that option at the time.

there are some really good videos of massage , triggerpoint , chiropractic, posture anything like that that you would want to see how it is done - it's so awesome - on those you tube and other video sites.

There are a few posted on the forum here but it's easy to do a search right on the Youtube or google videos.

here's one topic to get you started- these are great to explore and learn from
http://video.google.com/videosearch?...e+therapy&so=0

Thanks for the input and I'm online checking out the edge low technique right now. I just wanted to mention that for the first year after the car accident, I did as much aerobic activity as possible but I developed plantar fasciitis in that same year after a work-related accident so I was limited. It was about 10 months after the car accident when I was doing a lot of upper body strengthening (push-ups, using the exercise bands, etc.) with my aerobic activities that the thoracic outlet syndrome started in, though I had had neck muscle spasm the entire time. I blame it on the upper body strengthening, not the aerobic, and while I do some aerobic exercise now, I am very limited because though the plantar fasciitis healed, after the car accident my pelvis twisted as well and I was recently told by a chiropractor that because of that I developed degenerative disc disease in my lower back which caused a bulging disc at S1 that touches both nerve roots (I'm only 30 and was in great shape prior to the accident), and that the twisted pelvis has contributed my now having bursitis at the back of both Achilles insertion points in my heels for the last 7 months. I'm like the walking wounded! Literally. Sigh, I only wish that stupid car accident had never happened. Okay, now I'm regressing to a five-year-old, but it really has mucked up my body.

Anyway, anyone with any input on the Doppler ultrasound, let me know, though I did purchase the Journal article I linked above, and it showed that the high Cm/sec were from a rebound effect due to constriction and that normal blood flow is between 50-100CM/sec, so mine can be either normal, too low, too high, or not at all, thus the vascular TOS diagnosis.

Hello everyone,

Well, after seeing some marked improvement this summer with just myofascial and cranial sacral work, including going from a grip strength of 12 pounds to almost 30, I've decided to put off my first rib removal and scalenectomy for the time being. Unfortunately, I've been in a flareup since late last week and am now wondering if I made the correct choice. Rib movalization in PT irritated me, then I packed some small stuff for a move over the weekend and now I'm regretting it. I've been referred to pain management for a scalene block, but I've recently found that I do have tight pectoral minor muscles, plus restricted movement of my first and second ribs especially on the right side, so I might have a pectoral minor block performed first. Unfortunately, I live in Duluth, Minnesota and there might not be any physician here that performs these regularly.

One of the other reasons I decided to put off the surgery is that I'm moving to a condo the first week of September, also the same week I start graduate school. The condo is actually cheaper than this house, plus they do all of the lawn and snow removal which are two things I can no longer do. I'm really looking forward to the condo, though not the actual move itself. Some parts of me think that maybe I should've just had the first surgery and be done with it, but then I might not of found out about my tight pectoral muscles in time, or been off the pain killers in time for school. Argh, what an awful decision to have to make when there never is enough time.

Anyway, that's my update...

Best wishes to you all!
Melissa

Melissa, I think it makes good sense to postpone surgery until you are very sure---unless postponing puts you in danger or if you have a type of TOS that could lead danger of clotting. I too had the study at UnivMN and am awaiting results. (I don't know how to reference another thread and I don't know what "bump" is or how to do it) but see the thread "New Jordan, Ahn, and Gelabert paper" that Johannakat started.

I put a link there for a paper I found that explains the study. The tech didn't follow the protocol exactly and I wonder about that. He had me HOLD UP my arms (very difficult) instead of holding them up for me. The paper says that the resulting muscle tension gets in the way of the study if you have to hold them up yourself. Also, it says that only 5% or so have non-neurogenic TOS. If that's the case why do they go to such extremes to find out? Did you happen to get a follow up test? I think they mentioned a veinogram if a study shows vascular TOS.

In your surgery investigation it would be good to talk by phone with at least a few patients that have had surgery with your particular surgeon. They will tell you things you would never think to ask. I had those conversations and learned many details (but not w. Dr Molina's patients). So far I too have put off surgery. I think it's a good idea to get settled in your new space and make sure that you have all the support you need and everything lined-up before moving forward. One patient told me that she filled her frig with frozen dinners only to find that she couldn't hold the tray with one hand and cut the film with the other. I hope that you will continue to get better and be able to avoid surgery.

First, I agree with Fern that hopefully you can avoid surgery. I did have a rib re-section and scalanectomy. It did help. One thing I definitely agree with is IF you have to have this surgery or you know someone having any type of surgery, plan ahead. I injured my neck when I had three young children. My husband and I ran a business out of our home. Luckily my mother and mother-in-law were able to help. BUT, my neighbors got together and cooked dinners for us for a week. Now I'm not talking a baked ziti, or something simple. They made a full course meal. Salads, brisket, chicken or another main dish. veggies, potatoes, etc. plus dessert. I cannot tell you how thankful I was to these friends. It reminded me of how important friends and neighbors can be. Just one night a week for a group of people can make such a difference! Our Church, each year around Easter, takes turns making dinner for our minister and her family so she can direct her attention to the Church and all this time of year entails. She can come home and not worry about feeding her children.

Good luck with the move. That would be a very difficult thing when you are in pain. I've been in the same house for 15 years and don't ever want to move again! The last move I had a 2 year old and 2 month old!

Best wishes! Linda

ah, yes i see where you are with surgery, now

almost everyone with TOS (and many others who don't) has really tight pec minors- BTW, so don't be too alarmed !!! A very gentle doorway stretch might help- or just laying on the floor with your arms out in a T (or on foam roller if you can tolerate that.