I've been researching this a bit on the web and have found that there are a number of other names for pectoralis minor syndrome (or subcoracoid-pectoralis minor tendon syndrome), such as Hyperabduction Syndrome, and Wright's syndrome. I haven't found out a lot about treatment for it yet but it seems to predate TOS, at least according to this source:

http://www.medilexicon.com/medicaldi...ction+syndrome

So my question is, how were surgeons treating it prior to Dr. Sanders arrival on the scene? Was another surgical technique used? I will keep fishing and post what I find here...

A little more: I have been told that because TOS is made up of a constellation of structures (and therefore disorders) that can compress the neurovascular bundle (subclavicle arteries and veins and brachial plexus), any good TOS surgeon would know all about the possibility of impingement at the pec minor location. It seems that isn't always the case, or perhaps some TOS surgeons hope that by performing a scalenectomy and/or a first rib resection, the impingement will be lessened on the neurovascular bundle to the extent that the pec minor issue would become irrelevant. Of course, for that to be the case, the pec minor entrapment could not have been the major point of compression. Does that make sense to anyone? Anyone agree/disagree, or have other input?

Melissa

I have a thought to add...as I asked many of these questions myself.

For most TOS'ers there are several "fibrous bands" and scar tissue that develop to help the compression along...both in the neck area and in the distal region closer to pec minor.

As a standard part of the 1st rib resection, at least as I was told by Dr Reil (Dr Ahn's junior partner), a surgeon will detach any obvious extra fibrous bands near the pec minor on their way to the first rib.

Some doctors approach it differently, and I think there is a fine line between too much disturbance and getting enough out. For instance, Dr Filler makes a huge production of "cleaning up the area" by freeing every nerve, surrounding it with his favorite brand of neurological saran wrap, and then putting everything back together. He even makes a second incision at the armpit when doing a supraclavicular scalenectomy w/o rib resection to clean up the area near Pec minor.

Dr Jordan told me that his opinion is that it is best to disturb as little as possible to avoid the production of extra scar tissue "get in and get out!", since most of us are prone to it anyhow *and* by disturbing things you can generate more scar tissue as the surgical areas heals. He often looks at post surgical scar tissue by ultrasound, so he has seen the results of many different surgeries. (and has told me very seriously that Dr Ahn's technique is "excellent!")

Dr Ahn's approach seems to be to get the obvious stuff, but not disturb any more than neccessary to get the job done. At least, that's what I got by talking to him...I guess it is difficult for any of us to really know. And time will tell if that was a good approach for me

Sharon Butler points to the Pec minor often as a culprit in RSI & TOS -due to sticky fascia and impingements there.

Hello everyone and thank you so much!!! Fern I did have my symphatic nerve cut and right now I think it is too early to say my outcome, I know it has been 2 years but with having TOS and CRPS and now this pec minor it is hard to tell.
First what I just learned from you all it helped exspalin my hand is it right than with the pec minor compressing nerve bundle it affects hand? my hand is swollen and off color, alot of pain like the RSD/CRPS burning stabbing and my wrinst bone feels like it is in a vice at times, not constant but off then on also cold hurts it.
Also anyone if you can help, so with scare tissue you all say it comes into play right? befor my TOS I had shoulder surgery a open mumford along with bone spurs and reshape my bone and a slight tear, now when having my TOS and symphatic nerve cut I had scar tissue cleaned from the shoulder surgery, I was told we hope that this may be the problem (pec minor) but if not than it could well be scar tissue than if it is the case it would more likely be a on going thing to clean up scar tissue for the rest of my life is it true?
I hope that is what causing it and not my RSD/CRPS hitting me harder and spreading I'm at a loss it is all so complex, one can mirror the other and well it just plain HURTS! Thanks everyone..

I have three kinds of pain.

Skin burning like in a pizza oven, on surface, with sometimes surface knife stabs - that's my CRPS or RSD. It moves around, some weeks it's on my right arm. Then it moves to left. Then it moves to back of calves. Comes and goes.

Fibromyalgia - deep bone aching, deep muscle aching. Feels like bad flu. I get that on ankles, calves, arms, shoulders, back, hips. Comes and goes.

TOS pain - too many symptoms to list - but includes neck pain like I've been in a car accident yesterday - top of shoulder, shoulder, knife pain between shoulder blade and spine, middle of arm there is a big knot, little grape knots that form on back, spot by elbow, pain on forearm and hand and needling pain on thumbs, fingers and feet. These pains are constant, from a 6 to 10.

When all of these pains are going at once, it is too much.

I had my rib resection and scalenectomy April 06. For one year all headaches left, and so did RSD. Now bits of both return.

I have had TOS now for 5 years, from computer. I am totally bedridden, sick.

Tshadow thank you see that is what is going on the neck hurts like it's been whiplashed and stiffness in legs more on right side pain inbetween shoulder blades and right in the middle of my chest, my arm is swollen and hurts armpit is sensative still fingers are so swollen and fat along with hand, I cannot lay in bed breathing is hard I must lay in recliner. I have headachs mostly on the side of RSD and TOS operation above eye or behind eye the most that may be because of symphatic nerve cut? I got lucky no horners with how far they cut nerve, I may still get it though. I dont want to ask about Fibro yet is that my deep bone pain? it is nuts to exsplain but it feels like my bone is in a vice being squeezed my walking is getting worse my whole side of TOS and RSD just gets so flared up the muscles are so tight I cant walk I guess it is just normal for us than?
I feel I cant give in yet I must try to move my body more but I cant it bites me in the end, this sucks! I ask myself is it getting worse? I feel it is but I cant give up, this feeling I have is making it worse though I know I push too hard, one more step one more lifting arm up so on,and on is not right ughh sorry guys and gals just scared is all.
I really am scared of the needle touching my RSD side when they do the pec minor test since RSD I've had 2 needles stuck in RSD side by IC docs who hurt me bad, one was for testing dye for MRI and one was a doc who did not believe I hurt so he tried a general numbing shot and I had to held down because of the pain, I dont care if needle goes on unaffected side but MAN the pain it causes is GREAT.
Sorry I'll stop love ya all.

((((((Flippinout)))))))