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Thread: Do Para's use the phrenic nerve and scalenes to breath?

  1. #1

    Do Para's use the phrenic nerve and scalenes to breath?

    Hi

    This is probably a question for the sci nurses or Dr wise, but as a T5 para am I using the phrenic nerve and/or my scalene muscles to breath?

    The reason I am asking this question is that this week I was diagnosed with thorasic outlet syndrome on the left and right sides. My surgeon said my test results are conclusive, i definitely have it. Usually he would do surgery to correct it, which would involve removing the first rib and detaching/ removing part of the scalene muscles ( scalenectomy and first rib resection). These procedures carry a risk of damage to the phrenic nerve. But he says it is too risky in me as because I am paralysed I would be using the scalenes/phrenic nerve to breath due to not being fully able to use intercostal and abdominal muscles.

    I asked about using botox to paralyse th scalene, rather than removing it and having the risks of surgery but he felt injectin in that region risks damaging the phrenic nerve.

    I am basically trying to figure out whether these risks are as extreme as they sound?

    My dr- a vascular surgeon- is also trying to seek opinions from colleagues but this seems sci specific.

    For anyone not familiar with thorasic outlet syndrome, it is where the artery/nerves that go from your neck down your arms get trapped and occluded between the first rib and clavicle bones because the muscle becomes too big/ space in there is too small.

    The impact this is having on my life is HUGE. Besides extreme and chronic pain it is hard to push my wheelchair, dress, attend to toileting etc. So much as I hate surgery I am REALLY keen to get this treated if at all possible.

    Thanks in advance for any info you can give me
    "The impossible is just that which hasn't been done yet.Impossible is nothing"

  2. #2
    Everyone uses the phrenic nerve to breathe, it is what makes the diaphragm go up and down. But in short, we use all our muscles to breathe effectively from neck down to pelvis and we especially use them to cough (to clear lungs ) and women use more abdominal muscles to breathe than men.
    Of course, there is a phrenic nerve thing that could put in but... what he is basically saying since your intercostals and abdominals or not strong, losing the scalenes etc. is very risky and you would have problems breathing but you would also have problems clearing secretions and more chance for pneumonia etc...and not being able to clear that pneumonia without coughing.
    Thoracic outlet syndrome- is there anything other than surgery that could minimize the effects. Anything in your lifestyle making it worse? that could be modified. No heavy bags, way you transfer, equipment etc..- ex: there can be an impingement that is somewhat temporary or inflammation and might be reversible if lifestyle changed- no carrying bags on shoulders etc... from wheelchair etc.. use. I know we recommend Naproxen to decrease inflammation or use baby aspirin daily to help with keeping blood from forming platelets.
    If so you might look at possible modifications you can make to keep symptoms lessened.
    CWO

  3. #3
    Hi CWO,

    Thanks so much for your input, I really appreciate it. Gosh.. having the scalenes removed does sound dangerous and now I understand more fully why thanks to your explanation. I already have enough trouble 'coughing up' stuff.

    So onto 'managing it' in other ways.

    I currently take the anti inflammatory voltaren daily. Is this the same thing as naproxin?

    I get massage and physio weekly.

    I have resigned from my job which means less computers, holding phones, transfering to car etc.

    SO far I have cut out ALL sport and physical activity. I have stopped driving and pulling my wheelchair into the car beside me. I only go in a car with someone else driving maybe once a week to medical appointments.

    MODIFICATIONS I AM GOING TO TRY:
    1 I am looking into a power wheelchair for distances/outdoors.

    2 A car conversion to either a wheelchair drive (eliminate transfers but $80 000) or at least a boot mouted hoist to put wheelchair in for me (cheaper at $15,000).

    Any other suggestions?

    Thanks HEAPS
    "The impossible is just that which hasn't been done yet.Impossible is nothing"

  4. #4
    You may want to investigate Pat the Rat's ZX-1 which he has recently licensed to Spinergy. Nice alternative to pwr chair. You could leave the ZX-1 in the back of a van when you wanted to use your manual chair but for pushing distances or bad terrain hook up to the ZX-1. I am not familiar w what vehicles are available in Australia. Here in the US it would be possible to purchase a full sized van then have lift, hand controls and 8 way pwr seats installed w/o raising roof or lowering floor. This is the cheapest conversion for a van. If you were in US you could probably pick up something like this used from a mobility dealer. The 8 way pwr seat allows you to do gravity transfers in and out of seat. You could further reduce shoulder stress by coupling the seat w a transfer board. This is the driving system I use as I am a 66 yo T-10, 42 yrs post injury and am trying to conserve my shoulders for the duration. Good that you are being proactive to improve your physical situation.

  5. #5
    Thanks ancient gimp I have got on the waiting list for the zx1.

    Saving madly for vehicle conversion.

    I have also been put on a nerve pain drug called gabapentin, which doesnt seem to be helping

    However even with all the changes ive made Im still experiencing pain in my arms and neck, arm weakness and my fingers curling up- along with headaches and 'eye floaters'.

    My specialist is suggesting botox injections to paralyse my scalenes and assist with the thorasic outlet syndrome. As botox wears off it would be a way to see how my breathing is affected.

    Prior to the botox he wants to do an emg test- with a needle in the scalene muscle to see whether it is working when im at rest. But im worried this wont tell us how my coughing etc would be affected.



    SCI nurse, what do you think?

    thanks for your advice

    "The impossible is just that which hasn't been done yet.Impossible is nothing"

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