Hi everyone
Not feeling good as of late I have a few Q's for everyone. I know someone just had a pec minor surgery it was brought up to me I may need one also, but I had already had my TOS surgery the rib removal and scalen along with symphatic nerve for RSD. Has anyone else had this done after your TOS surgery? and did it help? I know I'm willing to try it for my pain is rising again, and it seems that my pec minor is constricting my nerves and hurts really bad. So any help would be good thanks...

Hi Flippin,
If I am not mistaken I think Beth did. Hopefully she will see this and answer you soon. I had the bilateral pec minor release 2 weeks ago. DR Sanders is pretty certain that's where my compressions was. And I believe it was too because my symptoms dramtically improved. Hope this helps! IHtos

Hi flippin',

I had my pec minor releases (bi-lateral) done AFTER the TOS surgeries.

It helped, but not enough to warrant losing the stability and movements that the pec minors give. My situation was weird tho - my insurance was running out in 30 days. I went to Denver and had nerve block done on the right side. It helped (and 24 hrs later I was having the surgeries). If my insurance was continuing, I would have opted to do nerve blocks for as long as they helped BEFORE doing the pec minor releases.

Now I'm experiencing tearing in my forearm and sternum - the areas that are trying to compensate for the pec minors. Also having lots of pain in the arm pits and pec minor insertion areas. Don't know why. Scar tissue?

Hope this is what you were looking for.

What is bothering you pain-wise the most right now?

Anne

astern--just wondering-what does Dr Sanders say about your sypmtoms post pec-minor release? Is there anything that can be done like strengthening or should time have a benefit to your situation? i really hope you get some relief post multiple surgeries.

flippin--have you had a diax telling you its the pec minor? what was the effect or removing the symphatic nerve?

Hi Fern,

I don't see Dr Sanders. My surgeon was Dr Annest and I havent called him about it. Our last conversation (1 yr ago+) was that there was nothing else he could do for me - more surgery was not an option, and dangerous for me and the only option left was a SCM implant. I need a Dr locally who can deal with 'me'. I have a Feldenkrais therapist who dx me with why I'm hurting in my upper arms and sternum and she gave me helpful hints on how to cope. But it's still difficult NOT to reach for that thing or use my arms away from my body/center of gravity.

astern thanks ! that is what will happen to me, I will get blocks done to see if it will be helpful to me. I worry also since having the procedure done I will have to use other muscles to compensate and I have other issues also concerning RSD, and other muscles that are doing the same thing. I do not want a implant and am afraid I will be told the same thing nothing else can be done and be released to PM which is ok but I think I will do or try to have blocks as long as I can. I will let you all know.

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..