45 year old male here with a wife and child. Live south of Boston. I've had two bouts with NTOS, the first about 3 years ago on the right side and currently on the left side.

I've been very active physically for years. Love working out. I'm about 6'2" 190 and consider myself in very good shape for my age. Unfortunately, it seems that this activity has triggered both of my TOS episodes.

My first experience started with what I thought was a simple shoulder injury. MRI was inconclusive and was told to do rotator cuff exercies for 4-6 weeks. The situation failed to improve and worse, my shoulder "impingement" pain turned into more of a burning pain on my scapula. For what seemed like months I kept trying to explain this pain to doctors, physical therapists, etc., but nobody really understood. I battled for months and then just decided to throw in the towel and have shoulder surgery. And then almost immediately after I made the decision, I had excruciating pain at the elbow due to ulnar nerve compression. Surgery cancelled.

This triggered a journey to visit doctors of all kinds...which seems common with us all. Neurologists, Neurosurgeons, more orthopedics, accupunture. Probably visited 15 different doctors. I was just about to basically give up and come to grips with the fact that I'd just be in pain forever when I decided to make one last call to a Dr. Kasparian at Lahey clinic. Almost immediately upon examination, Dr Kasparian indicated that I may have "transient thoracic outlet syndrome." He felt that my TOS was due more to hypertrophy of the scalene muscles because of working out. Many tests followed and an MRA revealed that my subclavian artery, on both sides, was being pinched by the scalenes. In Dr. Kasparian's words, "it was the real deal."

So at least I knew what I was shooting at. It felt great. I was then routed to vascular surgeons at Lahey. They found a "bruit" on my right side and felt that I should have surgery IMMEDIATELY. I was suddenly scared and felt a need to get 2nd and 3rd opinions. I searched high and low, found these message boards among others and somehow was lucky enough to find Dr. Dean Michael Donahue at Mass General. CT Scans were done and it was here that I found out that I was one of the lucky ones with cervical ribs. Dr. Donahue was hesitant to jump to surgery since I had managed the symptoms pretty well so he recommended botox. I received the injection and I haven't had issue on my right side or other since...

...until now.

Per my recent posts, I'm now experiencing symptoms on my left side. A throbbing neck, forearm, and hand pain has been with me since mid December. Most recently, this pain has been replaced with pins and needles. I'm doing a lot of therapy on my own and it seems like symptoms have diminished a little. I visited once again with Dr. Donahue who recommended another botox shot. This was done about a week ago. I'm hoping for the same results, but so far, no real improvement. Crossing fingers.

KY