Hi, I am a slim 47 yr old mum from the UK. I have lupus which has been troublesome over the past couple of years causing burning pain on the inside of my forearms during flares & more constantly from my left armpit to elbow particularly when yawning & swallowing. I now experience significant breathing problems when sitting, lying down in particular & at other random times too. When my chest is bad, so is the diffuse ache/pressure in my upper back and I cough much of the time (no infection, asthma or copd). I also have been having mild, intermittent ptosis and eyelids that can be slow to open after sleep. Cardiac screen is clear, SFEMG clear, no MG antibodies, CT chest shows 2 shadows thought to be old infections/inflammation, PFT's done 4 times in 2014 show diaphragmatic muscle weakness of 36cms h2o (normal 65+). I know that I breathe by hauling in my stomach muscles, my new osteopath tells me that my diaphragm is doing virtually no work.

My question is; do I assume that this is TOS or similar and rely on osteopathy to sort me out? How do I know if this has a more significant neurological cause or not? I was assessed by a neuro in March, he hinted at possible subtle proximal myopathy but nothing on EMG. I keep active but God, its hard. I can't even breathe when supine/prone on the couch long enough for the osteopath to do his work.

Hopefully someone with more knowledge can guide me on how best to sort myself out. Many thanks for reading.