First Rib Resection - understanding side effects after surgery

Thanks for everyone's comments first I'm glad I found this site to vent a little, lol.. As I mentioned before cervical ribs were my main problem in which I had a full set on both sides with joints coming off 7th cervical vertebrae which is vrey rare. EMG showed all ready major nerve damage prior to surgery so I knew the risk that it could be problems after and was explained in detail and underlying health conditions having an autoimmune disorder in which the surgery did throw completely into overdrive. This is the reason mine had to be done through the neck vs under arm. I did have surgery at 15 when I was hit by a car when they thought my clavicle was dislocated on the right side. My surgeon said at first they never should have touched me back then that after opening me up they probably didn't know what they were looking at with the extra ribs. I'm actually a home health nurse so I understand most of testing and procedures done but do to the rare ribs a lot of health care workers don't unless they have had direct experience with these patients. We do tend to have more of longer after care then most due to life long compression of the arteries and nerves. As of after surgery my wife went and bought me a bunch of pillows to put in the bed so I could sleep sitting up did that for about a month, body pillows work great, after I was able to lay down I use one large pillow to hug and sleep on the non surgery side as I still have a lot of pain if my arm if it is not in a neutral position. With going under the arm I'm guessing that they will tell you not to wear any constricted clothing until the wound heals and is comfortable for you to do so. Also going under the arm with the camera is way less invasive surgery on the body. As for the 1st rib it does take a couple of weeks for that to heal from being removed so keep a pillow with you if you go to cough will d we definitely want to support as if you broke a rib. Now with mine they also did a scalinectomy, this is where they cut and removed parts of the main musle that supports your head and aids in other movement such as shoulder and so on. So with that being said my therapist has had a hard time getting those muscles to properly work again and nerves to re fire to get everything back in motion. I'm glad I can share my experience with you guys and maby someone might get some help out of what I have went through. It can be a long hard road depending on what you already have going on. Don't be afraid to ask questions and most of all it will be ok everyone heals different some take longer then others and make sure to keep your primary care physician in the loop. Mine has been a big part of after care due to living 6 hours from where I had surgery and now taking my total care over. Thanks again for listening, it has helped me to get some of this off my chest, no pun intended, lol..

It was a really funny pun, intended or not 😉 I'm very comforted by being able to talk about this here as well. I'm single, I have lots of friends but while they are empathetic they obviously can't totally get it. And I don't want to burden them. Thanks for all the continued communication and support

As far as not being able to wear a bra, the solution for me was triangle bikini tops. The thicker the bands the better but string was ok in a pinch. The tying means adjustable, the thicker bands didn't cut as much as strings and it didn't touch my incision. After about 3 weeks I started wearing tank tops with shelf bras too. Took over a month for underwire to be comfortable. I hate not wearing a bra but the bathing suits made me feel more comfortable. Also I could wear them in the shower, at first the weight of my breasts seemed like they were pulling at the incision. I also have some internal stitches that go across my breast and it was more sensitive for a bit. Hope that helps 😊

Roger, I am so glad to know you are getting something out of this too and that I'm not just another pain in your neck! 😉

While reading your message I realized I had not shared the detail that I also have a full set of bilateral cervical ribs ...which is the main predisposing factor to my TOS. I was surprised that at my age and given all the imaging I've had in my life for one reason or another that not one single medical professional mentioned my bilateral cervical ribs to me. Not one! It was through my own review of my recent xrays and as part of my ongoing extensive research (advocacy and hobby that I discovered this seemingly obvious abnormality. Even though I had pointed this out to numerous doctor's before getting referred to my surgeon, not one of them confirmed this in their notes or to me UNTIL my surgeon a week ago today. I understand it is rare to have one and even more so rare to have them bilaterally, but they aren't "normal" or microscopic so I'm confused with why I was never notified in the past or why it has never been documented before last week. I wouldn't think it would matter if a doctor or radiologist was not familiar with cervical ribs. As long as they know what IS normal, wouldn't something like a couple of extra noticeable BONES be enough to alert them to the abnormality? I have just found it rather surprising that even Orthopedic Surgeons I saw looked puzzled when I mentioned my bilateral cervical ribs and I was asked how did I know this literally as they were looking directly at my XRAYS with me right in front of us. I honestly struggled to answer the question because I was so dumbfounded by the question. Even after this the notes included with their referral stated "PATIENT states she has bilateral cervical ribs." I'm truly baffled by this.

Ironically, the rare injury I endured when I was also 15 is more common to occur in car accidents. That injury was a left-sided Posterior Sternoclavicular Dislocation ... more simply said for those who prefer...my left clavicle dislocated backwards from my sternum and was pressing against my major heart arteries creating a life-threatening situation which required emergency surgery. My scar is 2" and directly over the left side of where my clavicle meets my sternum at the sternoclavicular joint. Because of it being a rare injury and therefore a rare surgical repair with very limited literature and documentation, I'm not convinced quite yet that it has not contributed more to my TOS symptoms as well. But as you know, there is no disputing the symptomatic cervical ribs factor. While my surgeon has not specified that a scalenotomy will occur, isn't this just part of the procedure since the bone it's attached to will be removed? I am looking forward to a more minimally invasive and scarring surgery this go round.

I have also been diagnosed with Fibromyalgia. I received this diagnosis within months of the onset of my symptoms and I believe that this diagnosis actually hindered the diagnosis of TOS for me. It seems to me that once I got "labeled" with it and given the stigma and controversy surrounding it that several Doctors I saw were way too quick to dismiss my TOS symptoms as being Fibromyalgia. I can't deny having Fibromyalgia, but I feel it is more of a sign or syndrome indicating that there is an underlying issue that should alert doctors to find the cause rather than for Fibromyalgia to be treated as a stopping point of being a condition in itself and alone. Like Horner's Syndrome, for example, which I also have like you. This has just been my experience being diagnosed with Fibromyalgia and by no means do I intend to speak for all Fibromyalgia suffers.

So far though, I have cleared Rheumatology testing! However, my Rheumatologist was one to quickly dismiss all my symptoms as being Fibromyalgia. He tested me for 4 specific conditions/disorders but I don't recall which ones. I'm pretty certain RA was one I was tested for though.

I've got pillows galore still from my pregnancy (yet another possible TOS factor) days so I think I'm prepared at least in this way! Thanks again Roger!

Great ideas Leah!!! As someone who has never worn a triangle bikini top I would have never thought of that. While I am not sure I can pull off a triangle bikini top even behind closed doors and under covers now, it does give me some better ideas. Something like a tarp with strings may work better for me! Lol. Even when I had a bikini body , I never found any triangle tops that provided enough coverage for my size and comfort. I've always loved the style though so maybe this is my chance to wear one ....I guess coverage doesn't really matter so much for this purpose just as long as I can get a little support fighting gravity.

Seriously though, I am nervous about my breast size and healing. The first suggestion made to me by my GP was to see a Plastic Surgeon about a breast reduction. His theory was that they were the culprit of all my neck, back, chest, and shoulder pains. I did go to a consultation and did find out that I met requirements at that time for insurance-covered breast reductions. However, I knew what I felt and that there was more involved than just that so I wasn't comfortable doing such a major surgery without feeling more confident that there was not something perhaps more serious going on. I'm glad I followed my intuition on that one, but the weight and size of mine is truly heavy and uncomfortable...especially so without adequate support so this has me really nervous about recovery. While I am just naturally top heavy, they became more of health issue following the birth of my 2nd son when they never reduced back to pre-pregnacy size despite the fluctuations in my weight. I do plan to discuss this concern with my surgeon more at my pre-op as well as get his input on the possibility of a breast reduction, but appreciate any additional ideas you may have knowing this. Unfortunately, it's unlikely I can find skinny straps, strings, or bands in my size. I may have to make due with just a camisole tank with built in elastic .... I can't see how that will possibly be enough for PT.

I apologize to the fellas on here and anyone else that may have been TMI for.

Just like you at 15 I stated before being hit by the car my injury was on the right side with clavicle dislocation about 2" up and has remained there until now with the right cervical rib gone which was bigger in diameter then the 1st rib if you can believe that with both cervical ribs having there own joints at c7 no one had ever documented mine either. Did not find out until a general surgeon did a scan and boom all the sudden there they were plan as day and been there since birth but no one noticed these huge ribs that weren't supposed to be there except an older surgeon that I had my pcp send to to for a mass under my arm. His first words when I came back for the follow up was mass if fine just fatty tumor but you have a big problem from a birth defect that I can't fix, then for the first time I was shown exactly what and where my problem was and was sent to the thoracic surgeon. Now 2 ribs less and my yin yang scars, I like to call them, lol.. one below my collarbone from age 15 and one now from above with both about 6" in length. Right rib was only causing problems started with loosing feeling in arm then fell off a ladder a couple of times after getting dizzy from placing my hands above my head and blocking blood flow, of course there are the numerous Er visits where I went in with unexplained chest pain and elevated bp, even stayed in hospital few times for that and always can't really find a heart problem.. If I would have know then what I know now could have maby been a different outcome I feel if someone would have just knew what they were looking at. That's why I don't blame the surgeon for the problems now, I actually blame all the ortho, cardiovascular and other specialist I have seen over many years. I would be interested if they are just going to take the 1st rib and leave everything else you will have to let me know on that. Also went to pcp this morning and going back for another EMG test follow up mri and a neuro surgeon to see if we can get full use of my arm back. Don't get me wrong I can move it, just very restricted and can't do a lot of daily task if I can't do them one handed. But hey got me out of a lot of house work, lol..

It's funny that you mention this top heavy thing because I think this might have been a contributing factor for me as well. For a fair bit of my life I was overweight and I carried a lot of that in my breasts. As I've lost weight I've lost a couple cup sizes as well and it is much more comfortable both physically and just out in the world. I think part of my poor posture was an effort to hide myself 😒 I think it's a major factor in TOS in women. Also, the cami bra top probably won't work at first because (at least for me) it hit pretty close of the incision. I feel like maybe there has got to be some sort of soft cup alternative that comes with more support/coverage. Even though I'm smaller know I still hate not having some sort of support/bra type thing. Makes me nuts. Old habits die hard 😊Also apologize to the fellas for tmi

Bless my husband (and your wife too) for the extra weight on them with housework! I never would have guessed I'd miss housework ... or working, but I really do. Looking at dirty windows and piles of laundry feels torteous at times. I sure do realize now all I took for granted when I had the abilities and hope I do retain this much post surgery.

The plan is to remove both my first and cervical ribs on each side. From what I can tell, I'm not sure how they would remove one without the other. I believe my cervical and first ribs have fused together at some point on each side.

Yes, Leah, you are correct in that large breasts are also a contributing factor as well. I've come across this in research from several credible sources. I actually packed on weight last year due to medications I was put on for the intended purpose to help me better manage my "Fibromyalgia pain". Well it didn't help. At all! In fact, I feel much worse. My weight has fluctuated over the years but has been more a struggle in the recent painful years.

I'm wondering if sports tape will be of any support? I will keep thinking about ideas. Let me know if you think of anymore. Thanks!!!

Yea they are usually an item near the breast bone. I have seen on line where people have had both done at once or within a couple of months of each other idk if I will do the second unless someone shot me in the head first, lol.. just kidding. As of the house work I'm now the supervisor for yard work she loves that a lot, mostly I get take your ass in the house, lol.. and back when it snowed last a couple of feet was right after surgery I couldn't even sit up on my own but did make it outside to show her how to run the snowblower... that was hilarious to watch... she has really stepped up and was great in the hospital. Make sure you have someone that can stay with you during your admission if goes well about 2 days, due to my collapsed lung I spent 3 days icu and 3 in a step down unit. If not for my wife I would not have had the care I really needed she only left the room to get food or to take a breather only when someone else come in to stay. Thank god she did because first night on the step down unit I woke up screaming in pain and come to find out after she called the nurse in that the nurse told my wife right in front of me "if the Dr wants to give him that much medication at once he can come give it himself" well the surgeon had given my wife his cell number and she promptly called him she returned within a few min with all meds and then we never seen her again the rest of the stay... support is a big part of the surgery and make sure you stay ahead of the pain if it's due take it and if they don't come when it's due call them. Worst thing right after is to let the pain get out of control.

lolll

Just an update been 4 months post surgery therapy visits 3 times week. Finally got a neuro and emg last week after I lost the use of my arm again with severe pain when trying to lift my arm lost all movement in shoulder in which i never had much at all. Neuro said one either I had an ischemic attack during surgery that caused muscle death or they accidentally cut the nerves that control my shoulder. Neuro actually said to me they messed up bad. Now I have to go for an mri of the bp nerves next week and now sending me to John Hopkins another hospital in US to a neuro musle surgeon to see if there is a possibility of getting my life back with another surgery. Also stopped all therapy due to declined every visit and now applying for disability per my pcp due to neuro said even if they could do surgery would be about 24 months recovery and if the nerve that he thinks was damaged that there is a possibility that I will never have full use again. Really just at my end with the pain and lack of sleep due to the discomfort. Pcp put my on more meds yesterday for depression and pain and finally took me seriously after all the reports come in that they really screwed up. I have always been active and it's time for kayak season in which me and my wife go every weekend. I'm not even going to be able to do that I guess anymore. I knew the risk going in to the surgery but never thought that I would end up a hundred times worse. Just feeling really bummed right now and needed to vent a little. Not looking forward to the mri due to they inject the dye straight into your spine, like I really want anymore pain. For the guys that are looking at this site for the first time don't be scared off by the surgery mine just went very wrong and this is probably due to a prior surgery I had about 30 years ago and a lot of scar tissue and the surgeon didn't finish the entire cervical rib resection due to the collapsed lung. I guess I was that 1%. Only thing I have really questioned in my head was my surgery was scheduled at 9am and they didn't take me back until 3pm due to the surgeon had complications with the cardiac pt in front of me. I woke up on the table at 8pm, actually on the operating room table because I could see the clock in front of me. Just wonder if the surgeon was fatigued and made some mistakes. If that would have been the case I would have gladly come back the next day or week. Well thanks for letting me vent a little tonight just sitting up because sleep has been something that just doesn't happen anymore. Thanks for the support and understanding that I know only you guys understand. Will gladly answer anything someone sends my way. Might take me a day or two due to md appointments ect but I will respond when I can. Best of luck to all you guys!!

Mri didn't get good results, right lung is herniating into scalene triangle causing splaying of subclavian artery and brachial plexus with compression entrapment of nerves between c8 and t1 and nerve injury and neuropathy with displacement / with scar related tethering of the lower brachial plexus and direct nerve injury. So basically he messed me me idk what is next at this point primary md is sending me to a larger hospital, set for permanent disability as of now due to loss of function of my arm not the results I wanted to hear today. Feeling really down and just wish that I would have not done the surgery at all, hating life at the moment and feeling really flustered. Glad all of you guys are doing good though looks like I'm heading back for repair from previous surgery.

I am so sorry to hear this Roger! I can understand how disappointed you must feel. I had my pre op appointment just yesterday and am headed to my first surgery on my left side on Monday. While being aware of risks and possible complications, there is SO much hope for relief and permanent repair. I can understand how devastating it must feel to come out experiencing futher pain and permanent damage on the other side. I don't know that I have words that may comfort you right now but please know you are in my thoughts and prayers.

Did your Doctor give you any idea which possible locations you may be referred to or how soon?

We are looking at going to John Hopkins I think at this point my original surgeon has wrote me off it seems that originally did the surgery they will not return our calls at this point. I think now I just got a surgeon that was not qualified to do the surgery at all. My primary care is stumped and horrified by the surgeon response. I have seen two neuro guys where I live and both said the same thing that it was a definite fail on the surgeons part. Now remember mine just went wrong because now I know that the MD did not know what he was doing, I got all you guys in my thoughts and hope that all goes well and the pain is relieved. Will continue to keep updated as I find out things. Also let us know how you are after surgery when you are able.

My surgery went well yesterday! I was discharged today. My shoulder blade seems to hurt the most since the surgery. I'm guessing that may be result of my arm being elevated for the few hours during surgery. I had to cough a couple times and that has caused the worst of pains ...feels like I am being stabbed all the way through my chest and back. I struggled with recovery initially because I was so nauseated from the medications and having a hard time breathing. Eventually they put me on a CPAP machine and I was able to eat then things got a little smoother.

Roger, have you had a consultation with any attorneys about your surgeon?

Wow great news glad it went well just stay ahead of the pain right now so you don't hurt to bad. Yea actually the surgeon refused to give the surgical notes up to me to go for a second opinion at a larger hospital so my attorney is having them court ordered. Can't remember if I said last week or not did have a mri last week with finding of herniated lung at the apex where they cut it, also damage from c8-t1 of the brecheial plexus is why I lost the use of my arm. The hospital I am now going to hopefully by the first of next week is going to fix my lung first then possibly a second to try and fix the nerves that they damaged. They have me supposed to be on bed rest but that isn't going to we'll lol.. told them been like this for 5 months but no one would listen. So glad everything went well I just got an idiot I guess the notes will tell all when I get them.

I'm glad they are listening to you now! I hope these new folks can reverse some of the damage done to you. Keep me posted!

I got my xray results from during and after my procedure. Apparently I had a partial lung collapse during surgery which is likely why I struggled breathing in recovery. I'm not sure I understand the results completely. The last xray I took AFTER my surgery indicated I have a Brachial Plexus Disorder ....but this is the first XRAY report I've ever had that stated that.....just not sure why after and not before. My shoulder blade is still hurting along the inside closest to my spine and feels real sore but I don't feel any pain in the thoracic outlet/inlet area. I have a little pain from the incision. The pain I feel around my shoulder blade is definitely the worst of it. When I woke from surgery all I could feel was the pain of my shoulder blade ....it felt as if it was out of place or winged. Anyone else experience this?

Ok, me dealing with this already with the collapsed lung in which they kept me a full week because your lungs don't fully inflate unless you use a sperometer at least once an hour and what we call the pickle where you blow into. You do have numbness where the surgery took place that will come back over time so the pain is deferred at this point to your shoulder blade because they moved all the nerves around and adm some local blocking agent's probably. Remember if they gave you pain meds stay ahead of the pain. The collapsed lung is a complication of the surgery. There for in my case in which is causing so much problems now is have your md stay on your lung issue and if your pain gets worse tell them especially if you feel like you can't move your arm the way you should. If there is a lung problem ask to see a thoracic surgeon that does nothing but that now!!! They are usually at the cancer center so don't be afraid if they refer you to them. One have they set you up for home health for therapy? Because it needs to start asap, two if you can't move your shoulder there might be a problem, and third if turning your head causes a problem to the affected side neck pain, headache, or blurred vision that could also be a problem. Have them stay on top of it and express your worries and where to go from here. Not trying to worry ya at all but just make sure you ask everything you need to. With the meds if they put you on high power it can cause memory loss so can being put to sleep for a few weeks. So with that said write down everything you are feeling. Also better to have someone to set your meds up for ya to prevent mistakes. That actually did happen to me, lol best sleep I had right after surgery.. also ask about a cpap for sleeping to help regain volume and help get a better sleep. I also think I said before surgery to make sue you don't sleep laying down, prop yourself up. It tool me about a month before I could lay all the way down. Hope this helps you some call your doctor if you are not doing well and make sure you include your primary care doc he was my life saver. If you need to vent or take I'm here, lol... I will answer any questions as soon as I can.. hope you feel better and remember your not alone.

Sorry for the type errors didn't read before that's what happens when your typing with your phone lol..

Thanks so much Roger. It is so helpful to have someone who has been through this to chat with!

I actually required a CPAP machine during my hospital stay to stabilize my breathing. Best sleep I've had in a long time!! My husband called my Doctor on our way home from the hospital to request the prescription for a CPAP....I did a Sleep Study last December and was diagnosed with mild to moderate sleep Apnea at that time but it has obviously gotten much worse. We were told it will take 5-7 days to get a call about a CPAP. I contacted the provider to see if I can get one any sooner but no luck on that. I do have the airlife breathing tool from the hospital.

The surgeon who did my surgery is a thoracic surgeon who works at a cancer center ....so I've already experienced the terror on that one before knowing not to. The last xray I had the morning I was discharged states that the partial lung collapse is "near completely resolved". I don't understand why no one went over these findings with me and that I am finding out only by the update to my online chart. I am ordering a copy of all the imaging tomorrow.

No one has said a thing about home health!? I told my surgeon I have already set my first physical therapy appointment up for 2 weeks post surgery and he asked me why ...then actually told me it wasn't necessary. I disagreed with him knowing that I need it.

I've been sleeping propped up in the bed with a gazillion pillows. I plan to try our Lazy Boy chair tonight instead to see if it's any better.

I can moved my arm and shoulder. My shoulder blade is signaling all the pain now and it just feels like it is huge. I do have pain meds and have tried to stay in front of the pain but the pain seems to be my reminder as it comes on when I can take my next dose. I actually wake up every 3 hours even when sleeping.

Tell me more about home health and any other information you may have. Again, thanks!!!

Yea I had home health after surgery, was ordered no driving for one month, and to follow up with my primary care MD in 5 days in which was a Tuesday because I was released on Friday. With another big surprise also even though I asked them about having 2 drains coming out of my chest while in the hospital I was not told they collapsed my lung, it was actually a nurse on the 3rd day that pulled the drains who messed up and told me while they were being removed. Although it is not common for that to happen with the above clavicle incision in my case still was a 10% chance. As of therapy I can't believe that they actually asked why you were doing it? That's what my home heath was. I had a physical therapist and occupational therapist that started right after and only makes since due to being told not to drive that they come to me. Also I lost the use of my arm right after surgery so a little different on my side but from my point of view the therapist is needed in any way after the surgery to keep joints moving and muscles from freezing up. Your primary care doc can also order that for you also for home health, they usually come 3-4 times a week straight out to your home to do therapy and not risk you driving on pain medication ect. I had them for a little over a month then switched to out patient that was about a block from my house. Although I never regained the full use of my arm I ran out of visits after 20 in out patient per my insurance. But I asked them again about home health if I still had visits left for that and they told me that therapy was unlimited in that form, so due to still on restrictions on driving to md, pharmacy or short trips to the store after my next appointments will be going back on home health to finish out therapy. Most insurance prefer them over a facility due to less cost. Also if you're shoulder and arm are moving as should you are in good shape. Just make sure when you lift that arm that your shoulder blade is not "winging" where it comes straight out verses sliding up like it should, if it looks funny to who ever checks you then I would probably go ahead and call the therapist you are already set to see and let them know what's going on, they may want to evaluate you sooner for treatment to prevent any long lasting side effects from surgery. Finally on the cpap I'm sure they had you on a full mask at the time, I fortunately have had mine for a few years after every one in my house said they were going to move if I didn't quit snoring, lol.. make sure you stay with the full mask I used the nose and pillows systems before and kept sinus infections until I switched to the full mask and yes I also never actually knew what sleep was until I got mine, if you do some reading also on sleep apnea you will see there are a lot of links to medical problems like high blood pressure, heart disease and increase symptoms in people with tos cervical ribs and the list goes on. Hope some of this info has helped and try to keep that arm moving, and make an appointment with primary care MD just for a follow up to let them know how you are doing and what you think you might need from them.

Ok, thanks! I will check back with you if anything new comes up or I have more questions. You have been VERY helpful! Thank you!!!

Just had surgery Thursday and was able to go home on Friday 6/17. Not a lot of pain the first two nights just pain seating and standing . Today I'm getting a sharp pain from shoulder blade to center of chest. Is this normal or should I be calling the doc

Hi,

Are you still experiencing issues with a winged scapula? If so, how long has it been and do they think you have nerve damage? 

Vanessa