First rib resection post surgical pain

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I was diagnosed with TOS about three months ago after years of going from doctor to doctor to figure out where the severe shoulder and neck pain was coming from. On May 3rd (almost 6 weeks ago) I had first rib resection on my right side, along with a scalenectomy and brachial plexus neurolysis. I am still taking percocets every four hours because the second they wear off I am in intense pain. The pain is both behind my scapula and goes into my arm pit, as well as the front side directly under and around the incision which is right above my collar bone. My question for people that have had this surgery, is this pain normal? It feels like my shoulder is getting ripped off of my body. Especially the scapula pain, it's enough to bring me to tears. I need to return to work within the next week and I'm completely dreading it. Any words of wisdom or similar experiences out there? I'm going crazy and I don't want to be on pain medication forever!

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  • Posted

    Hello Missy, literally in the 5 minutes before reading your post I had just tried explaining to my husband that it feels like my arm is detached and my shoulder blade is dislocated. I had my surgery on the left side just a week ago yesterday. The pain you describe is exact to the area of where I experience it except that my incision is under my arm. The shoulder blade pain was extreme upon waking after my surgery. I have thought it could be possibly because my arm was elevated for the couple-few hours of surgery, but I'm guessing yours was not elevated being that your incision is near your clavicle? I can only relate with the similar experience, but also welcome any words of wisdom. The side of my scapula near my armpit seems to be the most bothersome. It feels like they put rocks or left tools in there! I have been hopeful that starting physical therapy will help to elevate this lingering pain. Have you done any PT?
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    • Posted

      I'm so sorry to hear you are experiencing similar pain. I wouldn't wish this on my worst enemy! Its so hard to explain this feeling so I am glad you understand. I was not actually referred to a physical therapist. My doctor gave me a bunch of exercises to do at home, but said I would need a physical therapist who specializes in TOS or it would be useless. The nearest is an hour away and my copays are ridiculous, so I'm just sticking with his suggestions. I have found that icing constantly does relieve a bit of the pain, but it needs to be a long ice pack that can cover both the front and back. I've also been using a bag of veggies underneath my arm pit a few times a day which helps a little. But after 6 weeks I've been getting out of the house more often to go grocery shopping or run errands, and with the motions, lifting and inability to ice, there is a ridiculous amount of pain that accompanies it. My doctor did say that everyone was different and some people can take up to a year to be mostly pain free. Also, he said that some people remain on narcotic pain pills for up to three months with the possibility of using tramadol after that. But like you said, it almost feels like there is something in there by the arm pit deep in there. I was actually even googling torn rotator cuff because it still feels like something is really wrong. So weird! Hopefully in time it will subside more and more. Is your doctor lenient with narcotics? Dilauded helps the most but it's not good to stay on it for long periods of time. I've been on percocets now for five weeks and can't see going off of those anytime soon! Luckily my Dr. will prescribe them as long as needed. Hopefully yours will too!
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    • Posted

      I am still making it on the 1st prescription I got when I was discharged so I am not sure how open my doctor is to writing another or more prescriptions yet. I think they started me on stronger pain meds at the hospital that I wasn't tolerating well ... maybe what you mentioned above. I am hopeful I wont need them much longer but that may just be trying to be optimistic about it. My first post op appointment isn't until June 30th but I may need to make that call sooner.

      My co-pays for PT are high as well so I likely won't be able to go long term. My doctor required me to do PT prior to surgery but said I didn't have to post op....I know I need to do something.

      Google First Rib resection complications and scapula pain and/or the first rib resection and long thoracic nerve damage. I've found the closest match to what I am experiencing seems to be under these topics. Let me know what you think!

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    • Posted

      Another one to read is the wikipedia definition of the Serratus Anterior Muscle ... more specifically under the subheading Innervation....
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  • Posted

    Hello and sorry to hear of pain you have.
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  • Posted

    Hi, I am 8 weeks post op on the right and 4 on the left.  I used to get the scapula pain you describe pre op and for a couple of weeks post op always made worse by lying down.  It took about 8 months to get a diagnosis for me and as I thought it was a c-spine disc bulge to begin with I have always been taking Diclofenac 50mg three times a day.  This is a prescription anti inflammatory, whereas it sounds to me you are just taking painkillers and no NSAIDs. This is definitely worth a discussion with a Dr, bear in mind though if you are going to take NSAIDs long term you will need a PPI to protect your stomach, any Dr will know this.  I am still suffering with neck pain and headaches and I am fairly certain that this is due to muscle spasm as I have been to Physio twice now and it is already settling.  You do not need a TOS specialise Physio.  You just need someone who can help with the muscle spasm and can rehab all the muscles of your shoulder.  If it is muscle spasm that is causing your scapular and shoulder pain, heat is better than ice as cold will cause your muscles to go more into spasm.  I have a T-Shaped wheat bag which I microwave and wear around my shoulders in the evening.  Physio is exceptionally important, if you have only had one side done, your muscles are now imbalanced.  Do you have bilateral TOS or is it just the one side?  I have gone back to work this week and my consultant told me not to drive 100 miles in a day (quite possible in my job!), not to lift anything heavy or carry bags or rucksacks on my shoulders.  Also he said that symptoms (mostly the pins and needles) can take 3 months to fully settle.  My incisions are sub clavicular but I did have the underarm pain post op as my surgeon did dissect as much as he could down the pec minor but that has settled.  Other people on TOS chats have mentioned pec minor tenotomy but this is not my problem and not necessary.  I hope this helps.  Please feel free to ask any other questions on my experience as TOS does seem to be something that unless there has been an acute thrombosis or trauma it has taken most people months and year to get a diagnosis.  Which means for us all that there has been long term damage.  Take care
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  • Posted

    Hi Missy, sounds like you are going through what I have since my surgery February 2nd also right side and above the collarbone. I tried going back to work when they said I would be ready and was only able to stand it for under 2 weeks and been on disability since. The pain that you are experiencing is not normal, I was blown off by my surgeon and has taken me until this month to get anyone to take me seriously with exception of my primary care Dr and physical therapy who knew something was wrong. My primary care MD sent me for a follow up MRI in which showed the exact problem. But first did you have any complications during surgery such as a collapsed lung, what was your symptoms before surgery and how long did the symptoms go on for before diagnosis. Last can you move your arm normal now or is that where the ripping feeling in the shoulder happens especially when trying to lift up?
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    • Posted

      Heres an update i have..Got the results form MRI showed where I had the complication of the collapsed lung where they cut to far down into the thoracic space that caused a herniated area right where my 1st rib was removed. So every time I take a breath the top of my lung comes up into the scaline area pushing the muscle and entrapment of the nerves again. It also showed traumatic injury to the nerves between T-1 and C-8. I was put back on bed rest last Friday until I could see the doctors they set me up with next week in which is a neurologist / musle specialist, and a lung specialist all the same day with some other testing in between appointments. So now I'm just awaiting what's next. I lost the ability to move my shoulder upper are post op. I have done all the therapy visits that my insurance will allow for the year now (30 visits) which I started getting even worse at the end. If it wasn't for my therapist and primarily care MD we would have not found the problem at this point because the surgeon just blew me off. Even though my next appointments are at the same hospital I have scheduled a second opinion and sent all my records to a larger hospital to ensure that I am going to get the treatment I need. The original hospital does know this now and are aware that the other guys are going to be going through them also. Good luck but sometimes you have to do a lot of work to get the results you need and ask for copies of your medical records every time you go and keep a file so you have them on hand for any other persons you might have to see.
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    • Posted

      Wow, that's unbelievable that you've had to go through so much to find answers! I would think that after such a major surgery that a ct scan or MRI would be an automatic. I have only had xrays done since the surgery, 2 while I was recovering at the hospital and 1 at my follow up 2 weeks ago. He did not say that there were any complications such as pneumothorax during surgery, just that the pain I was experiencing is normal. I do have the ability to move my arm, but the more I do it the more pain I am in. It almost takes my breath away. I am waiting on a call back from the surgeons office so I will definitely bring up the possibility of more testing. I really appreciate your response and help!
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    • Posted

      Sorry- I didn't answer a couple of your questions! The pain has been ongoing for about two years and it started with a stabbing pain in the center between my shoulder blades. Soon after it moved to the right, next to and below the scapula and extending to my under arm. Soon after the pain spread to my clavicle area, and at that point I could barely lift my arm or write my name on a piece of paper. Also if I leaned on it, it would fall asleep within 30 seconds. The ripping feeling is constant, especially when I lay down. Sleep is still nearly impossible about 6 weeks post op. I don't know how I'm supposed to return to work next week.
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    • Posted

      My lungs also collapsed during the surgery and no one said a thing to me about it! I woke up in the recovery room gasping for air and dry heaving with severe pain piercing through my shoulder blade closer to the side near my spine at first. The nurse I had was aweful. I did not find out my lungs had collapsed during surgery until 2 days AFTER I had been discharged when the xray results were posted to my online chart. They actually moved me from recovery to a room without stabilizing my breathing. My young children had been waiting with my husband and mom to see me and I very specifically told them to NOT let my children in the room to see me while I continued struggling to breathe but they did anyway. My kids stopped at the doorway in complete fear and I could not believe they brought them back despite my instruction not to and after I explained it would scare my children. Eventually they listened to me and put me on a CPAP machine which helped me to stabilize my breathing and my kids were able to come back in and see me. Luckily my dad uses a CPAP machine so seeing me with a mask on my face wasn't as scary as seeing my hyperventilating and dry heavingredients at the same time.
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    • Posted

      Beginning to think we had the same surgeon, my surgery was scheduled for 9am and they finally took me back at 3pm per my wife. They woke me up in OR and I do remember the clock on the wall reading 8pm. Well no one was left in recovery so they had to call a nurse down. I remember asking for my inhaler due to asthma then coughed up lot of blood on the sheets and asked the nurse what's wrong with me. She told me that it was normal after having the breathing tube. Next thing I do remember was them bring my cpap I had brought from home and placing it on me due to she was hooking up the pain pump and pushing some meds in my IV. Next I remember waking up in the ICU unit with two drains coming out of my upper chest and asking why there was two? The nurse just told me that they had to make sure that all drainage was removed. I even questioned them on coming in twice a day and taking a chest xray and the reply was just checking for tube placement. It was not until the last day I was there and after being moved to a different room, near the end of the week that the nurse brought in the things they give you to help expand your lungs volume that you blow and in hail in to that she said my lung volume was a little low. My wife asked then what was wrong with my lungs and that's when the nurse told me that they had accidentally collapsed the lung. Went a whole week and no one would tell me just kept telling me to keep cpap on per md orders. Dr didn't say anything either each day him and the residents come in.
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  • Posted

    I recovered well,  but every body is different. If your having such pain still I would revisit it with your doctor/surgeon asap. There is no point in tourturing yourself and if something else is wrong you want that addressed sooner than later. I was supposed to resume PT afterwards but I'm having insurance "issues." I do the exercises I did prior to surgery, which have helped. I definately think PT helps to know your limitations. My surgeon was actually the most helpful by giving me some quick exercises to get my range of motion back. I'm about 2.5 months outy now since surgery and have periodic fits of pain but nothing like your describing. Best of luck. I KNOW how frustrating it can be, I have other isssues also, to NOT be healing or getting better as soon as you hoped.
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