Thoracic Outlet Syndrome Thoracic Outlet Syndrome/Brachial Plexopathy. In Memory Of DeAnne Marie.


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Old 01-14-2008, 09:32 PM #1
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Question Cervical Radiculopathy? Comments

I have noticed a couple of posts about cervical radiculopathy. I haven't researched the symptoms, yet, but, to start:

If you have an EMG / SSEPs / Nerve testing, they should test "up high enough" to the "C-8", which is where they stick the poker up on the back of your neck area. (I am repeating what Dr. Annest's neuro Dr. Mechanic of Denver was telling me as he was doing it.) IF there is "slowing at the C-8", and you don't need comparisons as there are expected norms by the way, although I agree it is more thorough and seems more sound to test both sides at the same time, but anyways, if there is slowing this TENDS to show TOS and NOT cervical radiculopathy.

Further, for cervical radiculopathy you need to see an MRI of the cervical spine. Almost anyone over age 35 will have notable findings of "degenerative disc disease" or "small 1 - 3 mm disc bulges" or some stenosis or drying of the discs. Almost all of the people who have these kinds of SMALL notable findings do NOT have cervical spine problems, or pain - ALTHOUGH it is still medically possible that even a 1mm bulge could cause someone pain if it just happened to be pushing on the nerve in a bad way. These are all generalizations, from the tons of talks I have had with cervical spine ortho experts and the TOS docs. So the MRI of the cervical spine is important to get your whole picture.

Finally, if you get a "scalene muscle(s) block" injection, and this is usually done by your pain management doc or sometimes a neuro, IF you get a result of relief, less pain or something notably BETTER, (this is a diagnostic test, not a solution), then again, it TENDS to conclude one to TOS. In fact, I think this is the MOST reliable, (if anything about diagnosing TOS is reliable), test.

Now, I have a question:

I know with RSD (CRPS) which many of us have along with our TOS, you get major color changes of your hand. (Other conditions also.) But here's my question, I know with garden variety TOS you DO GET COLOR CHANGES, such as high redness, we call it the "lobster claw." Now, question is, with JUST cervical radiculopathy, does one get this color change phenomenon? I am wondering if we can add the major red color change, (or blue, spots of coloring, etc.), as an indication of TOS vs. cervical radiculopathy.

I will try to research that later, as I think it's important to consider in our list of tests.

God bless guys.
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Old 01-14-2008, 10:12 PM #2
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I have had an MRI of the neck and my results were deg. disc disease in C4-C7 and slight bulging at those levels. I also have a reversal of the cervical lordosis which just adds to the spasming/constriction of the neck muscles.

When I had my EMG, they tested in C8 as well but as far as my results for the EMG, they were normal according to my Neuro. BUT my pain management Doc would like to redo the test as he feels it should have been done on both sides.

To answer your question, I do not get color changes in my hands. So maybe this means I don't in fact have "TOS." Doc does feel I have an impingement going on in the thoracic outlet, or actually I should say, the neck/collarbone area which is causing all my pain in my thoracic outlet. He also said I should have Trigger Point Injections as he felt numerous areas. He also feels this is directly related to my posture and repetitive strain and not extra cervical ribs, as I had xrays done and none showed.

ETA: not that age matters, but I am 23.
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Old 01-14-2008, 10:26 PM #3
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Yes, Missa, I have found out that age doesn't matter with TOS. There are two TOSers who got it when they were teenagers, and then there are quite a few who got it in their 20's.

There are several keys to your situation that I would like to know (or not necessarily know for me, but for you to consider.) Figuring out if we have TOS is so hard - I mean, for 1 1/2 years my doctor didn't say a word about TOS, and then, it was 13 or more docs later until finally I flew myself to Denver and saw two of the docs there who said, yes, TOS! So for me, it was not an easy decision.

Just because you do not have color changes, have normal EMGs, etc., does nto mean you don't necessarily have TOS. It's like you take all of these tests, and I think the scalene test is a really important tool - and then just by the entire case the docs (and yourself) figure out what you have. And there's not a rule that you couldn't have both cervical rad. and TOS, you know? Or, like I have, I should have a shoulder surgery and carpal tunnel release, but I haven't yet as the RSD is just too active, so I'm scared to do more surgeries. I did get some relief from the TOS surgery, so I am thankful I did it.

As far as the fibromyalgia, I think that people generally have that in their entire body - so it would be the tender points on the whole body, plus a whole body general pain. I DID develop fibromyalgia I think in my second year of TOS, and then after my TOS surgery, it got really bad for some reason. I will try to dig up my post where I try to describe the difference between TOS, RSD and fibro, as for me.

I am sure this whole thing is pretty scary. I remember when I first started searching the Net myself, to try to figure out why I was getting more and more pain, and less able to do my job and use the computer or write or get dressed, that when I saw TOS for the first time, and started reading about it, I really just cried and broke down at the computer reading. But, once you start getting involved in your PT, and working towards improving just every day, even in small ways, you start to feel you are getting some control back over your life, and for the most part, that severe panic and sadness I felt is often not with me.

And like we've all written here before, although this is truly a place where you can vent, and cry, and be angry, and we will always support one another, we also talk about the truth that there are people with worse situations, and look at stuff like the horrific killings in Africa, and starving. Not to be silly about it, but we have to rmind eachother that it could be worse! and to be strong, and we will pray for eachother.

So God bless you on your healing path, and I know that a lot of comfort is when you finally can put a NAME or names (diagnoses) on what is going on with your body, and then you can get on to your business of how you're going to conquer it.

We're here, and we care.


Just a P.S., I think an impingement on the thoracic outlet, or inlet, is in fact, TOS. The question is do you have vascular TOS, or neurogenic TOS, or a combo? The reason you want so many of the tests I list is that if someone has vascular TOS, then that means there is a clear and identifiable blockage on the veins, and it is very dangerous, as obviously there are a lot of emergency situations that can result from that - so in those cases, they usually go in on an emergency NOW basis to do the TOS surgeries. But TOS is called a lot of different names, like brachial plexus compression, etc. If you can Yahoo or google TOS, there are now (and this is relatively new) some good articles about TOS. I'll try to find some links below.

http://www.ninds.nih.gov/disorders/t...c/thoracic.htm

http://www.cnn.com/HEALTH/library/DS/00800.html

http://www.nlm.nih.gov/medlineplus/t...tsyndrome.html
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Old 01-15-2008, 02:02 AM #4
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I would only have color changes when my hands/arms were in a position that stopped the blood flow {white hands} and then when i returned to a blood flow positions { pink/red hands}.

I would have cold hands and swelling hands/fingers that had no relationship to hand/arm positions

for me part of the testing in regards to the symptoms being from the c spine or TOS { I have minor stuff at C4/5/6 = MRI & x rays}

The 2 PTs { 2 different places} did c spine positional testing that included some specific traction and compression maneuvers with tilting, turning etc - basically trying to reproduce some or any symptoms.
nothing changed - no pain or symptoms increased or decreased with those maneuvers - so that showed c spine was not the cause of my symptoms.

the change in the proper neck curves is probably an issue for most of us - part of the postural/ergonomic/uses relationship

Why it's so important to address all aspects - the whole picture - for life.
pain control
uses
posture/bodywork/alignment
ergonomics
stress/relaxation/breathing
water/fluids to keep tissues hydrated so they don't get sticky {adhesions}
nutritional/supplements

well this is just my list off the top of my head...
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Old 01-17-2008, 10:56 AM #5
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The color changes are caused by something called vasomotor instability. As far as I have been told this is not related to pinched nerves in the spine. My nerves to my legs are severely pinched in the spine and they don't change color. My arms, which have TOS, do. I think it is possible the vasomotor instability can be caused by other medical conditions but in my case it's clearly the TOS.
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Old 01-17-2008, 11:13 AM #6
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As for the difference between fibro and TOS, it important to know that lots of typing and shallow chest breathing, both common in TOS, will set up trigger points in many spots that are used in the test for fibro. So the doctor has to do a differential diagnosis between triggerpoints/ myofascial pain syndrome and fibro. It's important since trigger points are easier to treat.

I think trigger points are a local phenomema and fibro involves central nervous system effects but I could be wrong.

TOS often causes central nervous system effects as well, so thing can get confusing.
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