Well, I think...knock on wood...I've beaten this thing for the 2nd time.

As a quick review, I'm a Dr. Donahue patient at MGH and I've experienced two TOS episodes over the last 3 years. I also have cervical ribs. The first episode resolved with a botox shot on the right side. This second most recent episode on my left side is currently 90-95% resolved and due mostly to deep tissue massage, muscle strengthening, and much less due to botox.

In mid-December I started having debilitating pain down my left arm. This is after trying to rehab a shoulder injury for over a year and having shoulder surgery in mid November. I'm convinced that due to lack of mobility and muscle imbalance, my left shoulder became too internally rotated. More specifically, my pec minor shortened and my rhomboids weakened. This all pulled my left shoulder forward and crowded the thoracic outlet area. Worse, the pec minor and scalenes compressed my nerves. The result was serious weakness on my left side. For example, my left tricep probably had 20% of the strength of my right tricep.

After a month of flailing around, making no progress, and considering taking a leave of absence from work, I ran into an applied kinesiologist, David Leaf, down in Plymouth, MA. He debunked the whole idea of TOS and just indicated that had serious strength imbalances and posture issues. I was given a regimen of tissue massage and strengthening exercises. Six weeks later, the pain is 100% gone, I have just a hint of tingling in my index finger, and my tricep strength has increased to 60% of the right side.

I will say that after I started doing David Leaf's exercises/massage, I did have a botox injection. I'm not convinced that this time around it had as much impact as previous. The trending in pain/symptoms had started to decrease prior to the botox injection and continued along the same trendline to the current date. It may have helped me on the margin, but didn't resolve the problem completely as it did before.

I communicate all this because I think you can get yourself out of this mess...assuming your anatomy hasn't been drastically altered by some kind of traumatic event (like a car crash, etc.). I have cervical ribs. I didn't have TOS when I was 20. It's only now that it has emerged most likely to do with postural issues (i.e. daily computer work), my favorite activity (weightlifting), and the fact that I'm 45 years old (and I tend to lie on the couch in odd positions vs. run around in the woods like a 12 year old with perfect posture).

If you're willing to endure some pain and be systematic in your approach, this can be licked.

You can see more detail on the tissue work and exercises within this same thread.

Now I'm hoping I can keep myself out of trouble by sticking with this program on a daily basis.

KY