I share my researchs about TOS for free, on 11/12/2010, hope you like it.
RSI induced TOS :
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Based on the work of doctor Ellis, studies of RSI TOS's scalenes and RIF studies by Dr.Delanian and some others studies from some others doctors
Before starting...
EPO and heparin experiences :
http://www.doctorellis.com/lecture
TOS is caused by fibrosis of scalenes :
http://www.ncbi.nlm.nih.gov/pubmed/2301718
I- What is NTOS by dr ellis
II - What is RIF and effective treatment
III - TOS and RIF
IIIb- Neurogenic hypertrophic muscle, a role in TOS ? (important for VTOS)
IV- Treatments for TOS
IVb) Theory about costo-clavicular syndrome
I - What is NTOS by doctor Ellis
Poor posture + repetitive motions or trauma ---- > Neuronale inflammation ----> release of pro-inflammatory citokynes + (oxydative stress ??)----> Touch nerve and adjacent muscle ----> atrophic fibrosis around nerve (+ neurogenic muscle hypertrophy) . Then more trauma make the process spreads on the system and the symptomes goes worse (double crush injury). Sometimes fibrosis/hypertrophic muscle constrict blood vessel depending on morphology and location. This can happen anywhere.
Interesting abstract :
"What do we know about this mechanism? It must be primarily neural involving sensitized nervi-nervorum and communicating with local mast cells, monocytes, and fibroblasts to participate in the micro-inflammatory process that drives the pathology. This involves not only inflammation, but also the accompanying growth factors, which affect nerves, muscles (hence, the frequent scalene hypertrophy), existing fibrosis, as well as irritating nearby nerves, such as the vagus and, ultimately, the spinal cord (not to even mention activating the local innate immune response) to produce the insidious, cumulative, and devastating symptoms typical of NTOS."
Finaly fibrosis and constriction of nerve may start a de-differentiation process were the nerve return to immature.
That explain why there are no objective test for NTOS, because no damage or just a little.
Epo, a drug that induce differenciation give 80% relief on more than 50% people for weeks.
So doctor ellis call this "Neuronal inflammation-induced fibrosis". He say it is like post-operative fibrosis(1).
II- What is RIF and effective treatment
It is radiation induced fibrosis.
RIF is like TOS's fibrosis !
I find that RIF is reversable, trials are very impressive.
http://jco.ascopubs.org/content/21/13/2545.full
http://www.google.com/url?sa=t&sourc..._dG7MCH9oLYy3A
It is today largely accepted.
It is like the TOS fibrosis : Very active atrophic fibrosis with citokynes So RIF = TOS's fibrosis ? It's a good possibility.
About dr delanian :
Dr delanian made many studies about fibrosis, specialy RIF, she also write many officials book. In one other study, she show that Post-operative fibrosis is reversed by Pentoxifylline and Tocopherol(1):
http://www.ncbi.nlm.nih.gov/pubmed/18996041
I have found many incredible testimony on forums.
III - TOS and RIF
Rif is cured, so maybe TOS too, so we know compare these conditions.
RIF :
From a clinical point of view, chronic radiotherapy damage is a dynamic process that combines atrophy-contraction and connective hypertrophy-fibrosis in the same volume of damaged tissue.
http://jco.ascopubs.org/content/21/13/2545.full
TOS :
type II fibers were atrophied; there was an increase in the average number of type I fibers (78% versus 53% in muscles from control patients); and there was a significant increase (mean: 36%) in connective tissue (scar tissue) (muscles from control patients averaged less than 15%)
http://www.ncbi.nlm.nih.gov/pubmed/2301718
Near the same ! For details, look studies and docterellis's experience.
IIIb- Neurogenic hypertrophic muscle, a role in TOS ?
At least for vascular TOS; but maybe for all TOS;
(Sorry for police problem, the forum don't work well)
TOS may be neurogenic hypertrophy muscle AND spreading fibrosis on nerves.
What is neurogenic hypertrophy :
http://www.springerlink.com/content/t5v641820205812p/
The cause ?
chronic increased tone by excess of activity or motor neuron stimulation or spontaneous electrical stimulation of myofibers
It is reversible :
Once the scalenes are removed, abnormal atrophy automatically return to normal !
After tenotomy there is a reduction of type 1 fiber representation, selective atrophy in the type 1 fiber system (atrophy factor, 0.66 ± 0.24), and increase of type 2 fibers
http://archsurg.ama-assn.org/cgi/con...ct/121/10/1141
The question is : Is neurogenic hypertrophy muscle a part of TOS ? Or TOS is just a fibrosis so vite+ptx only can work ? i don't know.
Anyway if yes, stopping increased tone or motor neuron excitation will reduce symptoms at least.
If neurogenic hypertrophy muscle is part of TOS, carmabazepine may improve it, more than other nerve bocker.
IV : Treatments
- Treatment for fibrosis
Pento + vitamine e
or
Superoxide dismutase (SOD) alone
http://www.google.com/search?hl=en&c...=&oq=&gs_rfai=
http://www.lef.org/magazine/mag2005/...ort_sod_02.htm
or
Superoxide dismutase (SOD) + Pento
or
maybe omega3 hight dose (>2,4g) +Vitamine E
http://www.springerlink.com/content/v0g15522w0511653/ :
or
Heparin (maybe more powerfull than pent) + vitamine E
and
+ Anti-cytokine lifestyle
+ Eventually decorin therapy to prevent recurrence
For 6 months - 3 years
- Treatment for neurogenic hypertrophy muscle if it has a role in TOS
It may have role for all form of tos at some points
Once the scalenes are removed, abnormal atrophy automatically return to normal ! This suggest an implication in motor norons and excess of activity suggested by fiber type I dominance.
So a therapy of Phenytoin sodium may reverse it. Carmabazepine may be helpful too !
At least for RSI NVTOS.
http://www.ncbi.nlm.nih.gov/pubmed/6830473
IVb) Theory about costo-clavicular syndrome
Addionaly, fibrosis of scalenes may make them spams (part of neurogenic hypertrophy tissue), so the first rib is elevated. Add to this internally rounded shoulders by pectoralis minor (75% of NTOS have pectoralis minor syndrome from a recent study) and it can additionnaly compress artery, vein and nerves, depending on morphology, on the costo-clavicular space, so there are three space : scalene nerve only with fibrosis and nerve involvement, costo clavicular for vascular & neuro and often pectoralis minor, sometimes alone.
Pt : More space on costo clavicular
Relax scalenus
I think Reversing fibrosis with long terme anti citokyne + antioxydant and inducing differentiation, and Phenytoin therapy/carmabazepin need to be seriously examined.
Florian.