[pianoplayer]

I saw Dr. Sanders yesterday - what a great doc! He spent about two hours with me, talking and testing. He gave me a pec minor block and ALL pain disappeared - first time in almost 4 years. I couldn't believe it! Dr. Machanic's testing verified the diagnosis of pec minor syndrome, and as soon as I figure out the details I'm going to schedule surgery in Denver - hopefully in April.

Dr. Sanders thinks the pec minor tenotomy will take care of all my symptoms, but if not, I can have the elbow redo later. He says I shouldn't worry about losing any hand function yet as there is no sign of that. I'm kind of confused about why my muscles are fine, and my grip strenght is good, yet I have trouble opening jars, writing and sometimes playing piano. Must just be from the nerve entrapment?

Anyway, I'm so happy that I paid attention to y'all who told me to go to the best!

[johannakat]

Originally Posted by pianoplayer

I'm kind of confused about why my muscles are fine, and my grip strenght is good, yet I have trouble opening jars, writing and sometimes playing piano. Must just be from the nerve entrapment?

I was reading an abstract (sorry, don't have the link and probably could not find it without a lot of work, was not a Dr mechanic paper...think it was the french group), and then referred to my own report from the MAC that they usually see weakness in the abductor pollis brevis muscles first with TOS....i could not figure out exactly what that muscle did, but it is somewhere between the pointer and thumb..i bet that one is useful in opening jars, etc...just a thought.

Maybe also the one that wastes away with more advanced TOS??? Allie cat, Beth- any idea on that? I know mine showed weakness. I also have trouble with jars and many other things and my grip strength is "very high for a woman" I think it was 75 on one side and 90 on the other before surgery. Don't know what it is now.


Johanna

[trixlynn]

Good grief you guys have grip strenghth? Mine was 27 on the left and 22 on the right before surgery. They aren't much better now, 18 months later.
Pianoplayer, I am glad your appt. went so well.

[johannakat]

oh, duh, abductor pollicis brevis...stabilizing the thumb...

http://en.wikipedia.org/wiki/Abducto..._brevis_muscle

[johannakat]

trix- i once had my grip strenght measured at a health fair at a 5K race before i injured myself and I remember that it was off the women's chart, so it is all relative....

also, if you are in canada...the units might be different...ours is pounds/inch, i think. Yours might be metric.

[beth]

johanna,

yes, this is one of the most badly wasted areas of my rt hand - and besides the suicidal pain, one of the main reasons I was aggressive about getting dx, testing, treatment and on to surgery in just over a year. The rapid wasting and loss of function, especially given I am (was?) right-handed, was VERY frightening!

I'm short, 5 ft 2, and petite, with a small frame. Yet I've always had very good upper arm strength, from summers spent detasseling corn (NASTY farm work involving pulling tops off millions of mature cornstalks), my first car, a '72 Mustang II that had no power ANYTHING, and working as a roadie for friends bands (for beer) and as a waitress (to pay the bills). After marrying at 24, I carried loads of books across campus while finishing my degree, moved house every year or two, then lugged babies, diaper bags and strollers everywhere, so I didn't lose much of muscle strength, although I'm sure I lost some.

Yet before I went to Denver for the rib resection my grip strength was 17 on the left (good?) side, and 12 on the right! And the right side was my dominant side! I imagine pain may have affected the outcome some, but I know I have always given my best effort in these tests.

When I saw Dr Togut a year ago, his testing showed my left side is now WORSE than my right side. I do know I've had some recovery of certain muscles since the rib resection and pec minor tenotomy. But there is NO difference in this wasting between the thumb and first finger, and the pinkie still strays away from the rest of the fingers. The palm and fingers curl, so my hand doesn't lie flat unless I force it, which brings on pain at the elbow and plexus. I suspect scar tissue is responsible for this, or part of it.

The left hand is wasting in the same pattern, although slowly, and the pinkie is affected the same way. I have the same pains in the same areas of the arm, shoulder, chest, neck and back as I did on the right.

But with the SCS, and doing almost nothing, the pain is manageable. The surgery will make the RSD flare again, unless we can block it better somehow. (And there are some possibilities). So do I wait until my pain is unbearable, yet let the hand waste more and have less function, or try to save as much function and muscle as possible by getting rid of the compression ASAP? I really would appreciate any kind thoughts!!

beth

[painfree]

Originally Posted by pianoplayer

I saw Dr. Sanders yesterday - what a great doc! He spent about two hours with me, talking and testing. He gave me a pec minor block and ALL pain disappeared - first time in almost 4 years. I couldn't believe it! Dr. Machanic's testing verified the diagnosis of pec minor syndrome, and as soon as I figure out the details I'm going to schedule surgery in Denver - hopefully in April.

Dr. Sanders thinks the pec minor tenotomy will take care of all my symptoms, but if not, I can have the elbow redo later. He says I shouldn't worry about losing any hand function yet as there is no sign of that. I'm kind of confused about why my muscles are fine, and my grip strenght is good, yet I have trouble opening jars, writing and sometimes playing piano. Must just be from the nerve entrapment?

Anyway, I'm so happy that I paid attention to y'all who told me to go to the best!

You may want research myofascial trigger points. Since you play piano repetitive micro stress comes to mind.

Trigger points cause the muscle to become shorter and tighter. This limits the function and mobility of the muscle which causes weakness, decreased circulation and pain.

Neurological problems can also originate with tight muscles and fascia that can entrap nerves.
Based on your description the following muscles come to mind that could cause the hand and lower arm weakness: Scalene-especially the anterior, Sternocleidomastoid, Brachialis, Supinator, brachioradialis, opponens pollicis and adductor pollicis.

Nerve entrapment of the can be caused by the following muscles:
Radial nerve entrapment:
Cutaneous branch from the Brachialis muscle.

Sensory branch from the tricepts(lateral Head), and extensorcarpi radialis brevis muscles.
Deep motor branch from the supinator muscle.

Ulnar nerve both motor and sensory branch entrapment from the flexor carpi ulnaris muscle.

The Brachial Plexis from the pectoralis minor, omihyoid, scalenes-anterior and medial.

The greater occipital nerve can be entrapped by the Semispinalis Capitus and Trapezius – upper fiber.

The sternocleidomastoid alone can cause hand weakness.

Characteristics of a trigger point:
1.Exquisite tenderness in a taut muscle band
2.Referred pain elicited by stimulation of the trigger point
3.Local twitch or contraction of the taut band
4.Reproduction of the patient's spontaneous pain pattern when stimulated
5.Weakness without atrophy
6.Restricted range of motion

You may want to research this type of pain and dysfunction. You may have access through your medical library to the Travell & Simons’ Myofascial Pain and Dysfunction Trigger Point Manual Volume 1: Upper Half of the body and Volume 2: The Lower Extremities ISBN 0-683-08363-5 and ISBN 0683-08367-8

Best wishes.

[finz]

I'm glad that the trip to Denver gave you some answers and cause for hope