Surgery for thoracic outlet syndrome

Posted by snowmass @snowmass, Jun 13, 2024

Hello
Has anyone had surgery for thoracic outlet syndrome?
I have been to three tos specialists and they all have different approaches even wrt surgery. One removing some muscle, another removing first rib bone and muscle via clavicle area and another first bone and muscle via under armpit area. My tos is more of neurogenic and intermittent vascular. I have also heard mostly pt and therapists discouraging surgery as well as cases of no resolution even after surgery.
My immediate functional issue from it is pressure build up from the area to neck and head currently.
With added complication with cervical spondylosis and left lung removal from years ago.

Thanks in advance.

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Profile picture for dlcataldo @dlcataldo

I had the first rib removed because of TOS this was 20 years ago and the surgery was experimental at the time.
The surgery worked
Then 2 years ago I coughed real hard and my lung slipped up into my neck. They operated pulled my lung back down and put mesh in to hold lung down
Last week I coughed and it went back up into my neck again
I went back to the surgeon and he won’t operate again he said he thought he could fix it he tried and it failed he won’t operate again and fail again he said
So now I’m trying to find another surgeon to try and fix this

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My lung surgery was at National Jewish Hospital in Denver. Wonder if anyone there may have someone to help you…
Thank you for sharing your experience.
My recent additional finding is that there is a congenital dysplasia of c1 posterior arch (missing most of the right side vertebrae) from most likely underdevelopment at age 3-5, probably contributing to the CCI.
Life is full of surprises!
Best wishes to you…

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Profile picture for Jennifer, Volunteer Mentor @jenniferhunter

@dlcataldo Welcome to Connect. I didn't know that what you described is possible. My PT has done a lot of myofascial release and she said that lungs are mostly fascia. When I have allergy and breathing issues, she has done MFR and it can reach into the lungs at least from the top of them. I don't know if MFR could reposition lungs, but it may be worth asking an expert MFR provider. I typically get muscle spasms yanking my first ribs upward.

If you go to https://mfrtherapists.com/ there is a provider search.

This is our discussion on MFR:
Neuropathy - "Myofascial Release Therapy (MFR) for treating compression and pain"
https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/

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Thank you for the info I will look into this

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Profile picture for snowmass @snowmass

Yes we have. Since then my TOS has extended to my left side as well and currently getting a lot of sinus and eye pressure making much heaviness in the head. The doctors I have seen did not mention MFR but Botox injections and surgery as the ultimate solution with first rib removal for less chance for recurrence. Success rate they mentioned was about 74% if i remember correctly. Do you get much sinus/head pressure from TOS? Did MFR help with it? Because of my neck tightness/pain I am a bit afraid to combine my PT currently focused on Neck decompression with MFR for TOS… what are your thoughts?
Since I was denied from Mayo perhaps i should try Cleveland clinic…
As for my cervical issues, I have c5-6 disc burge and c6-7 stenosis with multiple areas of facet joint disease. Several doctors I have seen did not recommend any surgery but pain mgmt for steroid injection tries…

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I was diagnosed with TOS in both my my right and left shoulders ( clavicle area) how is the fire? I had an extra rib that was compressing on one side and restricting blood blood flow and oxygen to my heart and on the other side I had muscle and tissue that was built up and was compressing nerves on that side, which was also restricting flow and oxygen to the heart. When I was advised that it was that local, you know where I live in Tallahassee Florida and he wanted they wanted to do surgery. It was like 10 years ago and I was extremely invasive you know so I didn’t do anything and I just put it off thinking it’s not a big deal.. fast-forward 10-15 years later I begin having symptoms or losing sensation feelings and you know my arms like numbness tingling. I am right handed. The doctor told me that it was worse than my left side and it was my right but they you know he wanted he would do surgery on whichever one was bothering me first and then you know recover from that and then do the other arm and I still if you know it’s invasive and because of other health issues that I have I know is not looking to do surgery. The surgeon who is at a very great the best one you know that we have in our area I’m surgeon. He advised me that a physical therapy would not be beneficial towards me and actually said that it would make things worse because it would be putting pressure onto the nerves and everything that’s already having pressure so was strongly against physical therapy. I know that there’s three types of TOS on the top of my head at this moment, I cannot recall. I have two out of the three and has like came, followed up from my appointments. He didn’t push you know for surgery. He just wanted to let me know that you know the symptoms would get worse that I would not get any muscle or nerve damage nerve back in my hands that I’ve already lost like I won’t get it back and I know I was starting at that point because this is 15 years we know later was dropping things not be not able to fill things like right now I’m having to dictate this through my phone using the voice thing because my right hand it’s just like it’s it shot at it it’s very painful and in etc.. We all decided that that I should get a second opinion at Mayo clinic he actually is the one who said everything up and Mayo had a completely different story and it looks like my everything I’m saying is getting jumbledthat it will continue to get worse. He, you know he understood my hesitant aboI am dropping everything in my right hand losing nerves losing

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Profile picture for faith247 @faith247

I was diagnosed with TOS in both my my right and left shoulders ( clavicle area) how is the fire? I had an extra rib that was compressing on one side and restricting blood blood flow and oxygen to my heart and on the other side I had muscle and tissue that was built up and was compressing nerves on that side, which was also restricting flow and oxygen to the heart. When I was advised that it was that local, you know where I live in Tallahassee Florida and he wanted they wanted to do surgery. It was like 10 years ago and I was extremely invasive you know so I didn’t do anything and I just put it off thinking it’s not a big deal.. fast-forward 10-15 years later I begin having symptoms or losing sensation feelings and you know my arms like numbness tingling. I am right handed. The doctor told me that it was worse than my left side and it was my right but they you know he wanted he would do surgery on whichever one was bothering me first and then you know recover from that and then do the other arm and I still if you know it’s invasive and because of other health issues that I have I know is not looking to do surgery. The surgeon who is at a very great the best one you know that we have in our area I’m surgeon. He advised me that a physical therapy would not be beneficial towards me and actually said that it would make things worse because it would be putting pressure onto the nerves and everything that’s already having pressure so was strongly against physical therapy. I know that there’s three types of TOS on the top of my head at this moment, I cannot recall. I have two out of the three and has like came, followed up from my appointments. He didn’t push you know for surgery. He just wanted to let me know that you know the symptoms would get worse that I would not get any muscle or nerve damage nerve back in my hands that I’ve already lost like I won’t get it back and I know I was starting at that point because this is 15 years we know later was dropping things not be not able to fill things like right now I’m having to dictate this through my phone using the voice thing because my right hand it’s just like it’s it shot at it it’s very painful and in etc.. We all decided that that I should get a second opinion at Mayo clinic he actually is the one who said everything up and Mayo had a completely different story and it looks like my everything I’m saying is getting jumbledthat it will continue to get worse. He, you know he understood my hesitant aboI am dropping everything in my right hand losing nerves losing

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OK, I didn’t even read through everything that was transcribed on there. It is absolutely not and that you know done correctly. If you read it, you can probably obviously tell the long story short. I’m still trying to decide what to do when I went so when I went through the things with Mayo, the vascular doctor doctor along with other doctors that had to see to get certain things rolled out first we did a nerve block and they said if the nerve block worked it only last 12 hours, but if it worked if it helped that that would give them a better idea if the surgery is something that would be beneficial. When they did the nerve block, it was like an incredible how much more strength I had in my right hand. It was like I felt like I had a new hand for a minute, I wrote you know wrote down a few things Because prior to having this condition I was right you know I love to write notes, right hand write everything and I’m not able to do that now. In the same thing you know it was typing. It just messes up everything messes with daily everything anyhow so they decided it was the 70% success right if you will, if I were to follow through with the surgery, you know that that’s where it would be not to expect anything more than that. Also, maybe a background thing as well about 25 years ago 2025 years ago my owner nerve, I injured my ulnar nerve and my wrist and my elbow, and went to a orthopedic orthopedic clinic in the they like made. It seem like I had to have surgery you know like it was something major And at that time you know, I was just kind of listening to the doctor and let him do the surgery. I wish I could take that back because now that’s kind of plain into is it is it my ulnar nerve is that still being pinched or you know is that part of the equation? It’s just a whole mess wouldn’t which should upon our worst enemy and you know it’s just one of the several paths that of the House that I’m going down through. I apologize that everything probably does not make sense. I just encourage anyone to do as much research watch in the other get other doctors opinions prior to surgery. Also, I was diagnosed with connective tissue disorder, mayo, and that makes having the surgery even 100 times more scarier than than before. Yeah there’s a lot so and I know that everybody out there if you’re reading this, you have a lot going on as well, so I just wish everyone the best and I just I pray that for answers and to figure this out my kids and my parents are having to take care of me and it should be the other way around and it’s just I’m getting a very exhausting. I wanna be I want to. I just want my life back with my family. I know live life.

REPLY
Profile picture for faith247 @faith247

OK, I didn’t even read through everything that was transcribed on there. It is absolutely not and that you know done correctly. If you read it, you can probably obviously tell the long story short. I’m still trying to decide what to do when I went so when I went through the things with Mayo, the vascular doctor doctor along with other doctors that had to see to get certain things rolled out first we did a nerve block and they said if the nerve block worked it only last 12 hours, but if it worked if it helped that that would give them a better idea if the surgery is something that would be beneficial. When they did the nerve block, it was like an incredible how much more strength I had in my right hand. It was like I felt like I had a new hand for a minute, I wrote you know wrote down a few things Because prior to having this condition I was right you know I love to write notes, right hand write everything and I’m not able to do that now. In the same thing you know it was typing. It just messes up everything messes with daily everything anyhow so they decided it was the 70% success right if you will, if I were to follow through with the surgery, you know that that’s where it would be not to expect anything more than that. Also, maybe a background thing as well about 25 years ago 2025 years ago my owner nerve, I injured my ulnar nerve and my wrist and my elbow, and went to a orthopedic orthopedic clinic in the they like made. It seem like I had to have surgery you know like it was something major And at that time you know, I was just kind of listening to the doctor and let him do the surgery. I wish I could take that back because now that’s kind of plain into is it is it my ulnar nerve is that still being pinched or you know is that part of the equation? It’s just a whole mess wouldn’t which should upon our worst enemy and you know it’s just one of the several paths that of the House that I’m going down through. I apologize that everything probably does not make sense. I just encourage anyone to do as much research watch in the other get other doctors opinions prior to surgery. Also, I was diagnosed with connective tissue disorder, mayo, and that makes having the surgery even 100 times more scarier than than before. Yeah there’s a lot so and I know that everybody out there if you’re reading this, you have a lot going on as well, so I just wish everyone the best and I just I pray that for answers and to figure this out my kids and my parents are having to take care of me and it should be the other way around and it’s just I’m getting a very exhausting. I wanna be I want to. I just want my life back with my family. I know live life.

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Hi, I am sorry you are going thru so much pain. Having connective tissue issues results in many co- morbidities unfortunately. TOS is stated very common in this population as well as many other. I would recommend Dr Donohue at MGH for a consult. He is very booked but I read he does telehealth consult for venous TOS cases. When I saw him this month finally, he said that many have surgeries when it’s not TOS and subclavian vein compression on abduction is normal where some think it’s a sign of TOS. Because I am dealing with another cervical issues and could not complete the Botox trial, my evaluation could not be completed but said that I do not have typical symptoms. One thing I found out though from CTA done there is that I have enthesopathy at c7/t1 as well which cause can cause irritation on my ulnar nerve in addition to C5/6 bone spur and disc bulge which probably were caused by c1 defect which congenitally is weak in supporting the skull. All this is causing my TOS like symptoms sometimes even tightens my lung from spasms. Since you mention extra rib that sounds like a sure TOS but since surgery cannot be undone and with connective tissue issues I believe it’s very difficult to predict results. To be honest lidocaine scalene block injection is not enough of predictor. Hope you can get an opinion from Dr Donohue.

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