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Surgery for thoracic outlet syndrome
Bones, Joints & Muscles | Last Active: 19 hours ago | Replies (28)Comment receiving replies
I just got a scalene block injection yesterday. I could barely raise my arm for about 4 hours after the shot. Around 5 hours after the shot I went to my basement and started throwing a baseball against a mattress. My arm felt good as well as my shoulder. I only threw about 20 pitches so I didn’t really test the fatigue factor. I’m not sure if that means anything. I’m not really sure what the point of that test is. Today my arm is back to feeling heavy and tired, but still no pain.
The doctor who gave me the block said I had some of the tightest neck muscles he has ever seen. He said it was like sticking a needle through leather. When I told him how much throwing I’ve done in my life, he said that makes sense.
I have another ultrasound next Monday for a more specific look at the blood flow in my neck area. I have a follow up on the 11th with my vascular surgeon. I’m getting my questions ready.
Snowmass, are you considering surgery for TOS? It just makes so much sense due to my insane amount of baseball throwing in my life. I also feel like the symptoms started around 10 years ago. I was a pitcher in college, and about 10 years ago, I started getting dead arm after about 50 pitches. I couldn’t throw a strike. Lately it’s after just playing catch at around 20 throws. I just hope I didn’t damage something to the point of being unable to heal even if the compression is alleviated.
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@closer0043 In reading our conversation, I wanted to comment further. The scalene injection you had was likely to diagnose if that was the source of the problem, and you had temporary improvement. Ask your doctor what that means. I think that result may predict what improvement surgery may provide. When I had a spine injection done as a diagnostic, I also had temporary improvement and relief from pain prior to my spine surgery. I also wanted to mention that a collapsed C5/C6 can cause arm weakness. I did not have nerve root compression, but some slight compression of the spinal cord at that level caused so much weakness that I could not hold my arms up. Driving a car or pushing a shopping cart was exhausting, and I had to take a nap afterward. My spine surgery resolved that completely and I regained strength in my arms. That is important because I am an artist. I think my arms are not as strong as they used to be, and I still have TOS which varies depending on how tight my muscles are. That’s why I wanted you to know that both of those issues can generate arm weakness. I think it is very encouraging that you had temporary improvement from your injection. I will be very interested in knowing how things are going for you in your treatment as you go forward. If you do have surgery, perhaps afterwards MFR would be beneficial at that time. You may be interested in knowing that my journey is a Sharing Mayo Clinic Story. It’s harder to find now, but you can search for me along with Mayo and find it. I was grateful to my surgeon for saving my talent and I painted his portrait as a gift.
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At this point, I am not considering any TOS surgery because CCI and my upper cervical issue is bigger issue for me.
If your issues began that long ago with throwing and the heaviness you feel ( heaviness could mean nerve damage or compression ), I wonder if you may have some brachial plexus injuries. I am not sure if decompression surgery would fix it… although neurolysis is part of scar tissue removal common with this surgery it seems and nerve injuries takes very long time to regrow I read, like 1 mm per day if it can recover. If you can can you consult for brachial plexus injuries in addition to get a more comprehensive situation awareness? Can you do the Beighton score test (you can find it online and evaluate on your own)to see if you have hyper mobility? I read it’s not rare baseball players have the TOS issues or swimmers but if you are predisposed by hyper mobility, not sure what that means in terms of retaining stability after rib resection and scalene removals. All of the PTs I have met were against the surgery. I am due for MGH in July with Dr Donahue but Botox scares me because of my hyper mobility and my recent experience with Botox for cervical dystonia making my CCI much worse. I am hoping PICL procedure will put me in a better place by that appointment time so if I must, it can give better evaluation results. I am mostly counting on MGH expertise because my anatomy is already compromised with past lung surgery which resulted in right lung hyper expansion and cardiomedstinal shift to the left. Likely rib resection is not an option due to this because they push the lung out of the way to remove the rib from your under arm and I don’t have another lung to sustain me while. So my likely surgical option might be scalenectomy but I also met a girl who developed CCI after scalenectomy….
It’s complicated. Will see what Dr Donahue’s opinion would be.
My understanding of TOS surgery is decompressing what is abnormally compressing on nerve or vein. The 74% success rate is probably due to the difficulty of identifying the compressed locations?
One doctor also told me that a few repeat of Botox sometimes relieves the compression permanently but that probably depends on target location…
I am sorry I am probably confusing you more. I just don’t want anymore surgeries with long term negative effects but that varies person to person. Surgeries are making damage to fix something. Sometimes you need it, sometimes you can do without. Sometimes you never know.