21705 Division of scalenus anticus; with resection of cervical rib

Name of the Procedure:

Division of scalenus anticus; with resection of cervical rib

Summary

This surgical procedure involves cutting the front scalene muscle (scalenus anticus) and removing an extra rib (cervical rib) that may be causing nerve or blood vessel compression in the neck.

Purpose

The procedure aims to relieve thoracic outlet syndrome (TOS), a condition where nerves or blood vessels are compressed in the space between the collarbone and the first rib. The goal is to reduce pain, numbness, and other symptoms by eliminating the source of compression.

Indications

• Symptoms of thoracic outlet syndrome such as pain, numbness, or weakness in the shoulder, arm, or hand.
• Presence of a cervical rib confirmed by imaging studies.
• Conservative treatments for TOS have failed.

Preparation

• Fast for at least 8 hours before the procedure.
• Adjust or stop certain medications as directed by your doctor.
• Undergo diagnostic tests such as X-rays, MRI, or nerve conduction studies to confirm the diagnosis.

Procedure Description

1. Anesthesia: The patient is placed under general anesthesia.
2. Incision: A small incision is made above the collarbone.
3. Muscle Access: The surgeon carefully accesses and divides the scalenus anticus muscle.
4. Resection: The cervical rib is identified and removed.
5. Closure: The incision is closed with sutures or staples.
6. Post-operative care: The patient is monitored in the recovery room.

Tools used include surgical scalpels, retractors, and possibly endoscopic instruments.

Duration

The procedure typically takes about 1-2 hours.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Surgeons specialized in thoracic or vascular surgery
• Anesthesiologists
• Surgical nurses and assistants

Risks and Complications

• Infection
• Bleeding
• Nerve or blood vessel damage
• Recurrent symptoms if the condition returns
• Scarring or chronic pain at the incision site

Benefits

• Relief from pain and numbness in the affected areas.
• Improved mobility and function of the shoulder, arm, and hand.
• Reduction in symptomatic episodes.

Recovery

• Patients usually stay in the hospital for 1-2 days.
• Pain management with prescribed medications.
• Rest and avoid strenuous activities for a few weeks.
• Follow-up appointments to monitor healing and remove sutures if needed.

Alternatives

• Physical therapy
• Pain management with medications or injections
• Alternative surgical approaches such as transaxillary rib resection

Pros and cons of alternatives vary, and often depend on the severity of the symptoms and patient-specific factors.

Patient Experience

During the procedure, the patient is under general anesthesia and will not feel anything. After the procedure, they may experience soreness or pain at the incision site. Pain can be managed with medication, and most patients start to feel improvement in their symptoms within a few weeks. Comfort measures, such as rest and avoiding heavy lifting, are essential for recovery.