Thoracic Outlet Syndrome Support Group
Thoracic outlet syndrome (TOS) consists of a group of distinct disorders that affect the nerves in the brachial plexus (nerves that pass into the arms from the neck) and various nerves and blood vessels between the base of the neck and armpit.
Looking for the best TOS surgeon in the Seattle/Bellevue area. If you had surgery can you let me know who did the surgery, how long it has been since the surgery, and how you feel now? Thank you so much!
I don't know any surgeon's in the region you requested. However, the BEST vascular surgeon's who regularly perform 1st rib resection's for TOS are Dr Robert Thompson at Wash U and Dr Julie Freischlag at Johns Hopkins. In my opinion this is a surgery that is not done in high volumes and it may be worth the effort to hop on a plane and consult with either of these two docs. A few important questions to ask any potential surgeon who may remove your 1st rib are:
-- What is the surgical approach? (Transaxillary, supraclavicular, etc...). There are pros and cons to each approach and most surgeon's have a preferred approach depending on their training.
-- How much of the rib will be resected? Recent literature suggest the removal of the entire first rib during a first rib resection to prevent recurrence --> "Patients undergoing procedures for thoracic outlet syndrome should have the entire first rib removed at the time of the initial operation to prevent recurrence of TOS symptoms." ( http://meeting.savs.org/Abstracts/2013/P1.cgi )
-- How many 1st rib resection cases has the surgeon performed?
-- What are the chances to get a pneumothorax and/or how many cases have resulted in a pneumothorax? In my opinion this is not a big deal and is actually pretty common in this procedure and is not necessarily a reflection of the surgeon's skill or lack of skill. But I like to know that a surgeon has a mental record and can accurately communicate their history and experience with pneumothorax.
-- post op pain management. If you have no experience with pain meds- let your doctor know. If you know what works for you/doesn't work for you- let your doctor know. This will help them order the right medication and amounts post op. Consider asking for Lidoderm patches in addition to oral meds. A combination of a narcotic (oxy), muscle relaxer (soma), anti-inflammatory (ultram), and tylenol works well for the first 2-4 weeks post op.
-- physical therapy. It is a good idea to have a PT regimen about 4 weeks post op. The tendency is to protect your chest muscles and roll your shoulder forward. PT will help- but wait several weeks post op.