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Thoracic Outlet Syndrome Thoracic Outlet Syndrome/Brachial Plexopathy. In Memory Of DeAnne Marie.

Sufferring in Orange County, CA

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Unread 04-25-2012, 10:15 AM   #101
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That's great, Marc! It's funny how much you appreciate little improvements like that, isn't it? Are you catching up on any bad television or movies?
My wife is so tired of Law & Order and L&O Criminal Intent reruns that she bought me a pair of wireless headphones to wear at night to bed.
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Unread 04-25-2012, 01:14 PM   #102
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That's funny, Marc. My husband rolls his eyes at some of the stuff I've watched. He just smiles and moves along.
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Unread 04-25-2012, 03:06 PM   #103
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Thanks, Marc, that makes sense to me. I had full rib removal and anterior scalene removed with one supraclavicular incision exactly 2.5" long.
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Unread 04-25-2012, 03:15 PM   #104
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My understanding is that when the "UCLA" version of the transaxillary rib resection is performed the anterior and middle scalenes are only partially resected from the 1st rib (I've seen it referred to as a 25% scalenectomy), the subclavious is resected from the rib as well. The expectation is that these muscles atrophy and retract and do not cause future problems. I guess they are just left hanging.

The TOS info sheet Dr. Gelabert at UCLA gave me states that 10-20% of patients experience recurrence of symptoms and require supraclavicular full scalenectomy years later. Dr. Angle told me that making sure the rib is removed as fully as possible (no stubs), the chances for recurrence go down. He said he's only had one patient need the second surgery so far (I'm sure Gelabert and Ahn have been doing this much longer than Angle as he trained under them). The fact that I did not have scalene hypertrophy combined with Dr. Angle's addition of the arthroscopic camera leads me to believe my chances for this recurrence is very slim. Dr. Angle also stated that I now have plenty of space in in the outlet/inlet now.

If you want rib resection and/or full scalenectomy, the UCLA trained surgeons still remove the rib transaxillary and the scalenes supraclavicularly. I believe they feel there is less manipulation of tissue (especially the brachial plexus itself) when removing the rib transaxillary if my memory serves me correctly. I don't think they recommend doing the rib and the full scalenes the same day (I think Dr. Ahn may do it if you insist). I think the advantage of the fully supraclavicular approach is that you get the both the rib and the scalenes in one procedure vs two, but I think they have to move the brachial plexus around more and you still end up with two incisions. Someone please correct me if I am misinformed.

I firmly believe that the best approach each individual is the one your surgeon is experienced/comfortable with. I'm sure there are pros and cons to each.
So Marc Was yours Tranaxillary or Superclavicular?
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Unread 04-25-2012, 04:34 PM   #105
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My theory is that my brachial plexus has been rubbing across the 1st rib for years, forming the scar tissue and eventually fusing to the rib. I think the root of all of this with me is rib subluxations and nothing to do with my scalenes (which is why the scalene block didn't work).

My left side is improving rapidly. I'm typing with both hands right now and I think I will be able to drive by Thursday (just one week after surgery). I think I will be ready to return to PT with Dr. Ando next week (I follow up with Dr. Angle on Monday).

I'm going to have the right 1st rib resected soon (in May I hope), then I will continue therapy with Dr. Ando to fix my remaining ribs.

this makes sense to me. i dont have much scalene problem either unless it's just general fatigue or fibro flare.

could you hear your rib subluxate ever

congratz, that is very encouraging
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Unread 04-25-2012, 07:57 PM   #106
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So Marc Was yours Tranaxillary or Superclavicular?
Transaxillary. Dr. Angle trained at UCLA.
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Unread 04-25-2012, 08:09 PM   #107
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could you hear your rib subluxate ever
Never. I didn't know I had any rib problems (other than 1st rib) until the massage therapist said something and then Drs. Spousa & Ando pointed out all of the subluxations and torsions.
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Unread 04-25-2012, 08:11 PM   #108
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I had full rib removal and anterior scalene removed with one supraclavicular incision exactly 2.5" long.
Sounds like his technique is superb. What did he do with the middle scalene?
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Unread 04-25-2012, 11:06 PM   #109
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Marc, given what you've told me, I'm guessing he left it hanging since only the anterior scalene was removed. If you listen to his talk that I posted, it sounds like there are a multitude of different ways the scalene muscles can be divided anatomically. I'll try to remember to ask Donahue when I see him in several weeks.
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Unread 04-26-2012, 02:18 PM   #110
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Thumbs up One week post-surgical anniversary!`

I drove today! My wife is in a wedding this weekend and I was able to drive to the airport and back without a problem (12 miles each way). I've stopped taking Valium during the day to make sure I can stay alert. Luckily, I don't get any side effects from the narcotics (Hydrocodone) except constipation.

The numbness in my hand and fingers is fading away and my strength is steadily returning. I do still have numbness from my underarm to my wrist. I've been doing nerve glides and hope Dr. Angle clears me to return to Dr. Ando for therapy next week.
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