21700 Division of scalenus anticus; without resection of cervical rib

Name of the Procedure:

Division of Scalenus Anticus; Without Resection of Cervical Rib

Summary

The procedure involves surgically cutting and separating the scalenus anticus muscle in the neck without removing any cervical rib. This muscle is one of the groups of muscles that connect the cervical spine to the upper ribs.

Purpose

This surgery is performed to alleviate symptoms of thoracic outlet syndrome (TOS) caused by compressions, such as pain, tingling, and weakness in the neck, shoulder, and arm due to nerve or blood vessel compression.

Indications

• Persistent pain in the neck, shoulder, and arm.
• Tingling, numbness, or weakness in the affected limb.
• Inadequate response to conservative treatments like physical therapy.
• Compression of the brachial plexus or subclavian vessels confirmed through diagnostic tests.

Preparation

• The patient may be required to fast for 6-12 hours before the surgery.
• Medication adjustments, particularly blood thinners, might be necessary.
• Diagnostic tests such as X-rays, MRI, or nerve conduction studies may be done.

Procedure Description

1. The patient is given general anesthesia.
2. An incision is made near the base of the neck.
3. The scalenus anticus muscle is carefully accessed and separated.
4. Care is taken to avoid injury to nearby nerves and blood vessels.
5. The incision is closed with sutures.

Tools and Equipment:

• Scalpel
• Retractors
• Sutures

Duration

The procedure typically takes about 1 to 2 hours.

Setting

It is performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeons specialized in vascular or thoracic surgery.
• Anesthesiologists for administering and monitoring anesthesia.
• Nurses and surgical technicians to assist during the procedure.

Risks and Complications

• Infection
• Bleeding
• Injury to nerves or blood vessels
• Prolonged pain or discomfort
• Pulmonary complications, although rare

Benefits

• Relief from pain, tingling, and weakness in the affected limb.
• Improved function and use of the affected arm.
• Reduced symptoms of thoracic outlet syndrome.

Recovery

• Post-operative monitoring in the hospital for 1-2 days.
• Pain management with prescribed medications.
• Instructions for gentle neck and arm movements to prevent stiffness.
• Follow-up appointments to monitor healing and improve outcomes.
• Full recovery may take several weeks, with a gradual return to normal activities.

Alternatives

• Physical therapy and exercises aimed at relieving muscle tension.
• Pain management through medications.
• Less invasive treatments like botox injections.
• Surgery involving resection of the cervical rib if present and problematic.

Patient Experience

Patients can expect some pain and discomfort at the incision site post-surgery, which will be managed with medication. Swelling and bruising are common but will subside. Physical activity might be limited initially, with a gradual return to normal activities over time. Pain management and follow-up care are crucial parts of the recovery process.