thoracic outlet sydrome --new member
 

hello everyone , 6 years ago i lifted something heavy, had a wry neck and now im introducing myself to persons i can not see through a type of forum i have never used before. during the course of my problem i have suffered many of the symptoms that most people with TOS suffer. i believe that the medical practitioners are not looking at the problem logically. various medical experts have suggested that 1)the heavy arm feeling is due to vascular reasons. 2) TOS causes scapular instability 3) there is a changed breathing pattern in TOS sufferers (they chest breathe when they should be abdominally breathing, the suggestion being that chest breathing causes overuseof the scalene muscles thereby compromising the brachial plexus).4)the head forward posture is a cause of TOS.
I believe that their cause and effects are back to front.
1) The heavy arm feeling is not caused by vascular problems but instead it is due to varying scapular instability.
2) TOS does not cause scapular instability, scapular instability causes TOS
3) Many experts on TOS suggest that sufferers of TOS, chest breathe when they should be abdominally breathing. I believe that chest breathing causes partial compromise to the Long Thoracic nerve as it travels over the second rib. This then causes further scapular instability and greater compensation by the pectoralis minor which causes compromise to brachial plexus.
4) The forward head position is not the cause of TOS, it is a symptom. If the brachial plexus is being compromised behind the pectoralis minor muscle (as is suggested by some doctors such as Dr Richard Saunders) then the body's automatic reaction is to try and minimise the total compromise to the brachial plexus(BP) by moving the head forward and remove what would otherwise be normal pressure on the BP. the theory of cumulative pressure on nerves is called Double Crush. as i said this is the first time i have been a member of such a community. i need to go now i will list some of the measures which i have used to lessen my symptoms next time i log on

more stuff
 

hi everyone, please excuse me if i am doing this the wrong way i am not very computer literate and i have just spent 5 mins working out how to continue my story. i am assuming that this will continue on from the last episode that i wrote. in essence what i am trying to do is to ask people to consider their condition in different terms to what the medical profession use. if you go to a doctor and describe your symptoms.they may diagnose you with TOS.they will then stop listening to what you are saying and prescribe a bucket load of drugs, a physiotherapy programme that probably will make you worse and send you to a neurosurgeon who doesnt believe that TOS exists but is quite willing to perform some other invasive procedure to prove that is nerve root irritation that is the source of your problems. or if you are really lucky a neurosurgeon who believes TOS exists but tells you that surgery for TOS is only successful for 30 percent of those who have it. if anyone has heard of a person who has recovered from TOS can you ask them to list what they did to get better. my TOS began with pain in my upper back that made my neck very stiff and in the process my right arm felt so heavy that i was unable to lift things comfortably out in front of my body. not one doctor's report described the circumstances of my weak r arm as i had told them. i believe the way that my arm feels heavy is of great significance in trying to understand what is actually happening to cause TOS.
TOS sufferers often describe their symptoms worsening when they brush their hair or vacuuming the carpet, or carrying the shopping bags or reading the newspaper.
the medical practitioners use provocative tests such as costoclavicular test, the hyperabduction test which require the patient to hold the arms in the air or pull their shoulders back (stand to attention)
the manoevres which cause the TOS sufferer to a) have their hand, arm symptoms and muscle spasms in their sholders become worse are those manoevres which involve stabilizing ones scapula.
if one of the muscles that sabilize the scapula is not working correctly then other muscles tend to compensate for the weak muscle. it is my opnion that it is the compensatory muscles (pectoralis minor and rhomboids) which cause the problems of TOS (pectoralis minor syndrome) and myofacial pain of the erector spinae (T4 syndrome). got to go see you later.

post no.3
 

hello again, if anyone is interested i would like to mention the strategies that have improved my situation the most.
For the first 20 months of my problem, my condition deterioted markedly. i went from an injured shoulder and able to go on 10 mile bushwalks around steep terrain to three months later needing to lay down for most of the day. there were the very painful (8/10) muscle spasms in my upper back . no amount of capadex, celebrex, feldene, norflex, voltaren, vallium and other drugs that i have now forgotten would ease the painful muscle spasms. things were pretty bad. sleep was terrible, loss of and altered sensations in my right hand and arm.
A) there was one thing that a pt suggested that i do which changed my life around. the pt gave me a 5 inch diameter ball (chi ball) which could be inflated or deflated to suit my needs and showed me how to position the ball between my shoulder blades as i lay on it and relax my shoulder blades (scapulae) to the floor. the pressure and discomfort that it relieved was tremendous. i was telling people that i could now take my pain levels down to 0/0. the pt said that it was a thoracic mobilization exercise, i have seen the same exercise described by chiropractors as a pectoral stretching exercise. it became a necessary part of my routine to lay on this ball and take the pressure off of this area. when i do this i regain scapular stability. i believe that what i am doing is taking pressure off of the nerve which goes to a muscle called the serratus anterior which is under my shoulder blade.

Something changed physiologically in the months from being able to walk for 10 miles through mountainous terrain to needing to lay down for most of the day. i was lacking any energy. i was being told by physiotherapists that i was chest breathing when i should be abdominally breathing. Internet searches showed that many treatments for TOS involve a retraining of the TOS sufferer in the manner that they breathe, pilates, feldenkrais and yoga are used. researchers postulate that the autonomic nervous system is somehow affected, proponents of a condition called T4 syndrome (with symptoms like TOS) suggest that the nerves from T2 are affected, the nerve that cause bronco constriction comes T2. so somehow the physiotherapist is going assist the sufferer to correct a breathing condition that no one is really sure why it is occurring. what if they are unsuccessfull? As the condition of TOS is disputed and not well received by the medical community. complaints of strange symptoms are viewed with incredulity and are not given the significance that they deserve.

B) six years after my initial shoulder injury an x-ray of my heart to preclude heart defect as a reason for high blood pressure found that "the lung fields are over inflated and there are signs of chronic airways disease"
subsequent visits to pulmonary specialists (who asked that the x-ray be redone as she couldnt believe what she saw) and pulmonary function tests (involving continuous deep breathes which made my r upper back very sore again).my comments regarding the improvement that i had had when i had taken asthma medication previously and how it had improved my shoulder situation and the symptoms down my arm. prompted the specialist to consult with her senior and they prescribed a course of pulmicort.
not long after commencing the pulmicort the changes were evident. it was as though i was sleeping on a different mattress. Gastro Oesophageal Reflux which had been really bad since the deteriotion of my condition (an endoscopy 6 months after my injury showed that i had 3 ulcers in my oesophagus, they said it was due to the anti- inflammatory drugs i had been taking. since the endoscopy i had been taking somac at least 5 times a week). since the pulmicort and subsequent change in breathing in 12 weeks i have taken no more than 8 tablets. exercises which i have previously attempted (3 mile walks)and had left me tired and needing to recooperate by laying on the chi ball. now dont cause the same deteriotion of my condition. my arm is improving apart from a setback when a health professional manipulated the area near my scapula which caused scapula instability. i can't but help wonder if other TOS sufferers who may have the breathing problem might improve if they had similar treatment. i wish you well

I have copied over these posts from the new member forum so that towlehorse can meet the TOS members :)

Welcome towelhorse!

May I ask you a question? What do/did you do for a living? You write like a doctor or other healthcare professional.

Anne

One advanced PT suggested a Styrofoam cylinder to lay on for the same purpose of releasing and dropping the shoulders and such.

I found I like the large inflatable exercise balls even better - i use a 26" one.

I lay face up on it to do the TOS type pec/shoulder releases
also great for laying over on belly to stretch the hips and spine
also lean on it sideways while sitting on the floor with arm over it to stretch the pecs and roll on it to stimulate the lymph flow in that area too

just sitting on it and rocking uses core and leg muscles and side to side uses obliques/core/legs

to astern
 

hi astern i hope this is the correct method to reply to your question. the job which i was performing for 10 years prior to and including the time of my injury is installer of products such as awnings, indoor window blinds, inbuilt wardrobes. i am one of those people who work often with their arms above their heads and suffer from TOS. there are a few reasons that i may sound like a health professional. 1) after sometime i understood that the health system was not helping me get better and was in many ways making me worse. i decided to try and get an understanding of the different opinions as to why and how TOS occurs. the history of the understanding of TOS, RSI and other work related upper limb disorders is quite interesting. as a consequence i find that i may phrase sentences in a similar manner to that of medical professionals. 2) part of my rehabilitation for my work injury has meant a career change. i can no longer instal awnings etc. i now write standard manufacturing processes(SMPs) for my work place and i have been studying occupational health and safety at college. 3) it became apparent that medical professionals were not reporting the circumstances and conditions of my injury as i had described it. so i now describe it in ways that can not be misinterpretted. here in australia we have a party game called chinese whispers. someone whispers into the ear of the person alongside them a statement which has been written down, that person does the same to the person next to them, and so on. the joke is how much the original story is changed when it gets to the end of the line. see you later

post 4
 

hello towelhorse again.
i am wondering if anyone knows of a physiotherapist by the name of Christine Novak .Christine Novak and Dr Susan Mckinnon are the authors of an article called Thoracic Outlet Syndrome from Current Problems in Surgery november 2002 . if anyone can help me to contact Ms Novak i would surely appreciate it. the article in question describes in detail many of the symptoms that TOS sufferers report. if anyone who is reading this is a TOS sufferer if they wouldnt mind listing why and if they have these symptoms i would find it very interesting
1) the headache
2) the changed sensations in their hands and arms
3) the heavy arm feeling
4) why sleeping is so difficult most times
5) why they feel so tired most of the time
6) why their neck aches
7) why there are knots in the muscles in their upper back
8) if anyone chest breathes has anyone offered reasons for this occurring
9) why sitting with your arms out in front of your body for extended periods causes your condition to deteorate eg sitting at the computer
10) why bending down to the ground to pick things up is awkward.
11) why one day they might feel better or worse than another day
12) does anyone find that if they are sitting on a dining chair that they tend to lean back and move their feet foward rather than sitting upright.

best wishes towelhorse

welcome Towel horse, may I ask what area of the country are you in and also are you receiving WC.... you say you are working , but are they covering your medical??? If so may I suggest seeing one of the great docs out in Denver.... why they all seem to be in one place is beyond me, but they seeem to be among the best Ex; of docs out there: Ahn, Annest, Brantigan and Sanders. I myself am a bit prejudice and admit it, I like Dr. Sanders beside and knowledge, sure others are going to chime in here!
Below is an insert from Dr Sanders views:





Dr. Richard J Sanders, author of the book "Thoracic Outlet Syndrome", describes the cause,




Definition




Thoracic Outlet Syndrome (TOS) is pain, numbness, tingling, and/or weakness in the arm and hand due to pressure against the nerves or blood vessels that supply the arm. It is due to tight muscles, ligaments, bands, or bony abnormalities in the thoracic outlet area of the body, which lies just behind the collar bone. Pressure on the nerves is the problem more than 95% of the time, but occasionally the artery or vein is involved.



Common Symptoms



The most frequent complaints are numbness and tingling in the fingers; pain in the neck, shoulder, and arm; headaches in the back of the head; weakness of the arm and dropping things from the hand; worsening of the symptoms when elevating the arm to do such things as comb or blow dry one's hair or drive a car; and coldness and color changes in the hand. The symptoms are often worse at night or when using the arm for work or other activities. During the year 2005, we have become aware of a large number of patients who, in addition to these symptoms, also have pain in the anterior chest wall, just below the collar bone along with pain over the shoulder blade. Until recently it was thought that these later symptoms were also due to TOS, but now it has been learned that they are due to a condition frequently accompanying TOS, namely pectoralis minor syndrome.



Cause



TOS is most often produced by hyperextension neck injuries. Auto accidents that cause whiplash injuries, and repetitive stress in the workplace, are the two most common causes. Some of the occupations that we see causing TOS include, working on assembly lines, keyboards, or 10-key pads, as well as filing or stocking shelves overhead. In some people, symptoms develop spontaneously, without an obvious cause. An extra rib in the neck occurs in less than 1% of the population. People born with this rib, called a "cervical rib", are 10 times more likely to develop symptoms of TOS than other people. However, even in men and women with cervical ribs, it usually requires some type of neck injury to bring on the symptoms. Pectoralis minor syndrome appears in more than half of the patients who have TOS. It results from the same type of injuries that cause TOS.



Diagnosis



Physical examination is most helpful. Common findings are tenderness over the scalene muscles, located about one inch to the side of the wind pipe. Pressure on this spot causes pain or tingling down the arm. Rotating or tilting the head to one side causes pain in the opposite shoulder or arm. Elevating the arms in the "stick-em-up" position reproduces the symptoms of pain, numbness, and tingling in the arm and hand. There is often reduced sensation to very light touch in the involved hand (this can only be detected in people with involvement on one side).
In addition to these findings on physical examination of patients with TOS , patients with pectoralis minor syndrome have point tenderness just below the collar bone about an inch or two inside the shoulder (biceps tendon). Pressure on this spot often causes pain and tingling down the arm.



Diagnostic tests, such as EMG's or NCV's, may show non-specific abnormalities, but in most people with TOS, these tests are normal. However, during 2005 we have found a new nerve test which has been abnormal in the large majority of TOS and pectoralis minor syndrome patients. This test can be considered a variation of EMG/NCV measurements. It is a determination of the medial antebrachial cutaneous nerve (abbreviated MAC). We are currently in the process of reporting our findings in one of the medical journals and hope to have it published sometime in 2006 or 07. It is one of the few objective tests that can support the diagnosis.
Neck or chest x-rays may show a cervical rib. Loss of the pulse at the wrist when elevating the arm or when turning the neck to the side (Adson's sign), has been thought by some to be an important diagnostic sign. However, we find it unreliable because many normal people also lose their pulse in the same positions, and the majority of people with TOS do not lose their pulse in these positions. Shrinkage of hand muscles (atrophy) occurs in about 1% of people with TOS, and these people will have nerve tests that show a typical pattern of ulnar nerve damage.
Other diagnostic tests that are helpful are a scalene muscle block for TOS and a pectoralis minor muscle block for the pectoralis minor syndrome. These are simple office tests that involve a 15 second injection of novicaine or xylocaine into the anterior scalene or pectoralis minor muscle. The tests give strong support to the correct diagnosis if within a minute of two of the injection there is good relief of symptoms and improvement in physical exam findings.



Disease Process



Microscopic examination of scalene muscles from the necks of people with TOS demonstrates scar tissue throughout the muscle. Presumably, this was caused by a neck injury stretching these muscle fibers. The tight muscles then press against the nerves to the arm (brachial plexus) producing the hand and arm symptoms. Neck pain and headaches in the back of the head may be caused by the tightness in these muscles but also can be the result of stretching muscles and ligaments along the cervical spine of the neck in cases of whiplash injury.



Treatment



Treatment begins with physical therapy and neck stretching exercises. Abdominal breathing, posture correction, and nerve glides, carried out on a daily basis, are a part of the therapy program. Gentle, slow movements and exercises are stressed. Methods like Feldenkrais have helped many people with TOS. Modalities to avoid are those that emphasize strengthening exercises, heavy weights, and painful stretching. It is important to be examined and tested for other causes of these symptoms because other conditions can coexist with TOS, and these should be identified and treated separately. Some of these associated conditions include carpal tunnel syndrome, ulnar nerve entrapment at the elbow, shoulder tendinitis and impingement syndrome, fibromyalgia of the shoulder and neck muscles, and cervical disc disease. Surgery can be performed for TOS, but it should be regarded as a last resort. Non-surgical forms of treatment should always be tried first.



Surgical Treatment
Surgery for TOSis designed to take pressure off the nerves to the arm. This can be achieved by removing the muscles that surround the nerves (scalene muscles), by removing the first rib, or by doing both (removing muscles and first rib. Over the past 30 years we have employed each of these 3 operations in a quest for the safest and most effective procedure. All 3 procedures( transaxillary first rib resection, scalenectomy, and combined rib resection and scalenectomy) have limitations; there is no perfect operation. When we analyzed our results for the 1990's, it was observed that the failure rate for scalenectomy with rib resection or without rib resection was the same. This has led us to use scalenectomy without rib resection as our operation of choice. However, when during the operation we observe the nerves to the arm being pressed by the first rib, we will remove the rib during that operation. In the year 2004, during which time over 100 operations were performed, the first rib was removed in 7 patients.
Recurrent symptoms of pain, numbness and tingling is most often the result of scar tissue formation during the healing period. This occurs regardless of which operation is performed. During the past 4 years, 2002 through 2005, we have covered the nerves to the arm with a material like Saran Wrap or more recently, by a material like cellophane, that is designed to reduce scar tissue adhering to the nerves after surgery. The material is totally absorbed within months so there is no foreign body remaining. The material has now been employed in over 350 patients and, to date, the failure rate has been reduced, although not eliminated.
In 2005 we became acquainted with a condition that was described 60 years ago but which most of us had ignored, the pectoralis minor syndrome (described above under "cause" and "diagnosis"). Each patient we now see for TOS is also examined for this. We have been surprised to find that at least half the people who have TOS also have complaints and positive physical exam findings of pectoralis minor syndrome. If following a pectoralis minor block these is significant improvement within a few minutes, we have been performing a very simple operation called pectoralis minor tenotomy. This operation is performed through a 3 inch incision in the arm pit. The pectoralis minor muscle is easily found and cut at its attachment to the shoulder blade (at the coracoid process). One inch of the muscle is then removed to prevent it's reattachment to the top of the nerves going to the arm. The incision is closed with buried stitches. The operation usually takes less than 30 minutes and can be performed as an outpatient. The procedure carries almost no risk of injury.
In 2005, we performed over 50 pectoralis minor tenotomies as the only operation. 35 of these were performed in patients who previously had been operated upon by scalenectomy or first rib resection. They had experienced partial improvement in their symptoms from their operation but continued to complain of pain in the chest and pain over the shoulder blade. Separately, 16 pectoralis tenotomies were performed on patients who had not been operated upon previously. They had been seen because it was thought they had TOS. On exam, most of them did indeed have TOS, but also had findings of pectoralis minor syndrome. When their symptoms and findings on physical exam were dramatically improved by a pectoralis minor block, they were offered the simple operation of pectoralis minor tenotomy with the understanding that if they did not experience good relief of their symptoms they could return for the bigger operation of scalenectomy or first rib resection. To date, 2 patients have returned and received scalenectomies. The other 14 have had so much improvement that consideration of additional surgery has not been necessary.



Results of Treatment



Most people with TOS will improve with stretching and physical therapy. In our experience with over 5000 people with TOS, less than 30% had surgery. The improvement rate with surgery varies with the cause of the TOS. Auto injuries have a success rate of about 80% while repetitive stress at work has a success rate of 65-70%. Pectoralis minor tenotomy has only been performed for the past year. The success rate to date is between 80 and 90%.





For more Information



More information regarding TOS is available in the book: THORACIC OUTLET SYNDROME: A COMMON SEQUELA OF NECK INJURIES. Written by Richard J. Sanders, M.D. and Craig E. Haug, M.D., the book was first published by J.B. Lippincott Co., Philadelphia, in 1991. Lippincott elected not to reprint the book when it sold out its first printing. However, the publisher has given permission to the author to reprint the book and it is now available by phoning his office, toll free, 1 888 756 6222. If you would like to discuss your TOS problem, feel free to call the author, Dr. Richard Sanders, M.D., in Denver at 303 388-6461, or call toll free, 1-888-756-6222.
Dr. Sanders is Board certified in both General Surgery and Vascular Surgery. In addition to his book on TOS, he has authored several articles in medical journals and many chapters in surgical textbooks on the subject of TOS. He has been treating patients with TOS for over 30 years. During this time he has seen over 5000 patients with TOS and performed over 2000 operations for this condition.
Last updated: February 2006

reply to DDAYMBB
 

Hi DDAYMBB,
thankyou for that information. dr sanders mentions that he is now performing the pectoralis minor tenotomy on many of the patients who didnt achieve the desired outcome from their previous scalenectomies. it would be interesting to know how the pectoralis minor is causing compromise to the brachial plexus when prior to a neck injury it wasn't. i live in australia so the doctor options are not relevant. i wished to contact Christine Novak re an article that she co-wrote.
i have a theory about the whole TOS situation. i wish i had the computer skills to design jig saw puzzle shaped boxes where one could list differing aspects of TOS.
Dr Sanders mentions
1) THORACIC OUTLET SYNDROME: A COMMON SEQUELA OF NECK INJURIES
2) worsening of the symptoms when elevating the arm
3) Pectoralis minor syndrome appears in more than half of the patients who have TOS
4) Some of the occupations that we see causing TOS include, working on assembly lines, keyboards, or 10-key pads, as well as filing or stocking shelves overhead
5) pain in the neck, shoulder, and arm; headaches in the back of the head; weakness of the arm and dropping things from the hand
6) The symptoms are often worse at night or when using the arm for work or other activities
7) Abdominal breathing,carried out on a daily basis, are a part of the therapy program

i would then like to add two more boxes
8) typically in patients with TOS, there will be weakness in the middle and lower trapezius muscle and SERRATUS ANTERIOR MUSCLES. from an article called Thoracic Outlet Syndrome from Current Problems in Surgery november 2002 by Novak and McKinnon
9) Perhaps the most important anatomic feature associated with injury is the course of the long thoracic nerve through the fibers of the middle scalene muscle in the supraclavicular region.Several patients in the current study were thought to have sustained an insult to the nerve through direct compression by the middle scalene muscle during contraction while exercising.
dr rahul nath texas nerve and paralysis institute.

i would then rearrange the boxes in this order

1) wry neck (for what ever reason)
2) scalene muscle spasm
3) partial long thoracic nerve compromise
4) serratus anterior weakness
5) scapular instability
6) other scapular stability muscles try and compensate
7) resultant postural changes due to shoulder girdle instability
8) pec minor over compensates for serratus anterior when reaching forward and up. causing pec minor syndrome.
9) rhomboids over compensate and cause thoracic spine tightness
10) to compensate for pressure on brachial plexus (BP) ones head moves forward releasing what would otherwise be acceptable pressure on the BP.
11) occupations which may not have caused the problem (wry neck) now certainly exacerbate the problem because the long thoracic nerve can now be compromised in other ways when the scapula is unstable (the bow stringing affect)
12) shoulder girdle strenghtening programs exacerbate the problem for the same reasons
13) for some (disputed) reason chest breathing occurs further compromising the long thoracic nerve.

this is my theory on the process . i have TOS and after 3yrs i was diagnosed with partial long thoracic nerve palsy causing serratus anterior weakness. obviously the experts have noticed the similar serratus anterior weakness in other TOS sufferers. I cant help but wonder if they are thinking that the significance of the scalene muscle compromise (wry neck) is misplaced. it is not affecting the BP but instead the nerve to a scapula stabilizing muscle which if it is not working properly then causes another compensatory muscle (pec minor) to to the compromising of the BP. i am having trouble convincing people of my theory. thankyou for reading this towelhorse

Wow. I keep coming up with the serratus anterior muscle when i search to find out why my pain is so severe in my ribs. Also when searching for stretches for that area.
It's the outside of the ribs, from the armpit down. Not in the middle chest like Costochondritis. I find it impossible to wear bras, etc. It doesn't hurt to breathe, just when touched or if I lie on my side.
Most of my TOS pain is posterior shoulder pain, bilaterally. Thats how this whole mess began. Then went to spasms in my neck and traps, then arm turned numb. Ulnar nerve is numb in the whole arm.
I've never had much pain in the front of my neck or upper chest area. Mainly pain in upper back ,ribs, arms and hands. Mine is vascular, and neuro TOS.
Very interesting reading towelhorse. ihtos

Thank you Towelhorse
 

Dear Towelhorse,

I haveto say when I read your response and your symptoms, I got teary-eyed because that's exactly my symptoms.
************************************************** *****
1) worsening of the symptoms when elevating the arm
2) I'm a secretary --------- Some of the occupations that we see causing TOS include, working on assembly lines, keyboards, or 10-key pads, as well as filing or stocking shelves overhead
3) pain in the neck, shoulder, and arm; headaches in the back of the head; weakness of the arm and dropping things from the hand
4) The symptoms are often worse at night or when using the arm for work or other activities

1) the headache
2) the changed sensations in their hands and arms
3) the heavy arm feeling
4) why sleeping is so difficult most times
5) why they feel so tired most of the time
6) why their neck aches
7) why there are knots in the muscles in their upper back
8) why sitting with your arms out in front of your body for extended periods causes your condition to deteorate eg sitting at the computer
9) why bending down to the ground to pick things up is awkward.
10) why one day they might feel better or worse than another day
11) does anyone find that if they are sitting on a dining chair that they tend to lean back and move their feet foward rather than sitting upright.
************************************************** ***
I've never found someone who could pinpoint exactly what my symptoms are. I've also been told that I probably have RSD... I had rib resection surgery 2.5 years ago, am not better and probably developed RSD because of the surgery... I am so glad that you found a physical therapist who is able to help you.

Thank you so much for your contribution to this board. Everyone's experience and symptoms are different. But, it's nice for me to have someone else who can pinpoint and understand what some of us may be going through.

:) :) :) :) :) :) :) :) :) :) :)

Is this her? Christine B Novak, PT, MS,

Author: Christine B Novak, PT, MS, Clinical Coordinator, Division of Plastic and Reconstructive Surgery, Research Associate Professor, Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine

Coauthor(s): Susan E Mackinnon, MD, FRCSC, FACS, Program Director, Division of Plastic and Reconstructive Surgery, Shoenberg Professor and Chief, Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine; Mark E Baratz, MD, Professor of Orthopedic Surgery, Medical College of Pennsylvania, Hahnemann School of Medicine; Vice Chair, Director and Program Director, Department of Orthopedic Surgery, Allegheny General Hospital

Christine B Novak, PT, MS, is a member of the following medical societies: American Association for Hand Surgery
more-
http://www.emedicine.com/orthoped/topic537.htm


page 6 might be interesting ?? actually beyond that is interesting too - I clicked for the HTML version but you can use PDF too
by way of MD names & topics that attended the -
AAHS 36th Annual Meeting
January 11-14, 2006
Loews Ventana Canyon Resort, Tucson, AZ

Program at a Glance
page 6 - http://72.14.253.104/search?q=cache:...ient=firefox-a

post 5
 

hello everyone,
i just spent 30 mins writing something which was a satirical comment on the medical system and how it is not meeting our needs but on reflection i have chosen not to post it because there are people who are looking for help not a smart alec critique of the systems inability to comprehend our condition.

i have made tremendous improvements over the last 6 months

i have thought for sometime about the things that make my condition worse they are
1) using my affected arm--it would be so bad that i would have to put it in a sling, i found that if i had a commitment that was in the evening, if i put my arm in the sling during the day prior to going out my condition (all aspects) was more tolerable.
2) sleeping--i have on many occasions awoken to find a) that my neck and head aches (i hate these)and b) my scapular stability (ability to lift my arm out in front of my body, pick things up, open jars) is much worse than the night before. i have spent hundreds of nights on the lounge. i slept on the floor evey night for over a year, with only a 1inch thick mattress.
3) bending down to the ground to pick things up, twisting to get into cars, sitting for long periods
4) putting the affected arm behind my back and trying to reach up my back would be extremely painful and i would lose scapular stability
5) if i had to stand on something that was unstable such as skateboard it would cause muscles in my back and rib cage to go into spasm.


these are the things that i have done that have helped enormously

1) a) taped my shoulder back, this stopped 90% of the funny hand and arm symptoms ( i no longer need to tape my shoulder back apart from one incident when a health professional caused my situation to worsen)
b) i have for the last 3 years worn a shoulder brace made from 2 inch elastic. this has stopped 75% of the muscle spasms in my upper back , the one i use now, i make myself. the brace by itself did not stop the hand problems. when the tape has stopped the hand problems you only need the brace to maintain that situation. the width, positioning and tension is critical. i will try and post a picture of it.
2) one night in 2002 i could feel the neck and head pain starting to happen so i layed on the floor on my chi ball between my shoulder blades. it was late at night and to make it more comfortable i got my special pillow (a pillow that the pt suggested which has a longitudinal divide in it which, for a reason that i dont know, it is much better than a normal pillow) i fell asleep on the floor. when i woke up in the morning i didn't have the horrible neck and headache that i had had for most of the previous 2 years. this in itself is a great thing not to have that happening. the next night to make things more comfortable i used a 1 inch thick sponge mattress that we had. this is a sad thing to be sleeping on the floor and it provided much humour for some people, but who cares i wasn't having those headaches. My hips became really sore to the point where i was limping for the first part of the day. so i got another mattress and placed it on top of the first mattress. but when i made it more comfortable the headaches started coming back. So hipache or headache? we had an OT appraise our situation and she suggested a new mattress, the insurance co. approved. the mattress we chose was made from the hardest industrial rubber available. the mattress co. had never made a mattress from this rubber before. the first morning after sleeping on the new mattress i had the head ache again. in desperation i asked my wife to tape a hard foam block to my spine between my shoulder blades for when i was sleeping. To cut along story short i now have one of those gel wrist supports folded in half and fixed to an old elastic shoulder support positioned between my shoulder blades and i dont get the headaches as long as the support doesnt move. i know for absoute sure that those headaches happen when one is laying on ones back and placing pressure on the affected shoulder blade. Take the pressure off of the shoulder blade and the problem disappears. the reason that i wasnt getting the headaches when i was on the floor was because it was too uncomfortable for me to lay on my back. As soon as i made it more comfortable i started laying on my back and putting pressure on that shoulder blade. the other times i have had the headache are when a health professional has done some work on my shoulder or when i have disregaded the pain and used my shoulder when i shouldn't have done so.
3) when one has irritated the nerve (long thoracic nerve, LTN) and the area between ones neck and under the scapula is sore. if one bends forward and down and stabilizes the affected scaplula the increased pressure in the thoracic cavity places greater pressure on the LTN. if one has put on weight and has a bigger belly this makes it even worse. many TOS clinics suggest the TOS sufferers must lose weight and be aerobically fit if they are to be successful in beating TOS. they don say why losing weight is vital to success. i believe it is because if youre overweight each time you bend forward you increase the pressure on the irritated LTN.
I found that i could not sit down and put my affected arm out in front of me (stabilize scapula) without feeling very uncomfortable. As part of my rehabilitation in 2006 i spent some time in an office. i was required to do some work on a computer. this made the hand/arm symptoms increase. the area that i was in was an area that i wished to be employed in the future. a colleague was going to be in late one day so i took the opportunity to try her ergo chair. the difference was obvious. the ergo chair placed my knees lower. their was obviously less pressure on my diaphragm. this caused less chest breathing, less pressure of the ribs on my LTN. i purchased a foldable ergo chair i use it anywhere i need to sit and use my affected arm out in front of me. recently i have been using pulmicort this has stopped the chest breathing which has decreased the pressure on the nerve. you would not believe how different sleeping in ones bed feels when you are not chest breathing.
4) an occupational physician caused a significant reaction (nerological) when he asked to put my affected arm behind back lift it up and then push away from my back with it. it caused a significant set back in my improvement. it is important not to do as have described. most medical people testing ypu want to see what your limits are. at he endof the day they go home and enjoy themselves, you go home and suffer, it is critical that you advocate for yourself.
5) less use of my affected arm means less pressure on the thoracic spine from compensatory rhomboid muscles. dry needling in erector spinae muscles. chiropractic corrections to the thoracic spine. less compromise to the LTN
(by whatever means) use of a hot wheat bag. and importantly the elastic brace mean that i could now easily stand on a skate board without muscles going tight. i dont have anywhere near full scapula stability i am hopeful that non compromise of my LTN will mean a recovery

a whole heap of circumstances and conditions caused me to get scapula instability and then TOS (age. occupation, fitness, inappropriate rehabilitation, reluctance to stop the things that i wanted to do, wrong medication[aspirin induced asthma, that is reaction to NSAIDS] family committments)

it is obvious that it is requiring a whole heap of preventitive measures to ensure that i dont suffer most of the insidious effects of TOS. but no medication would stop those disgusting headaches. Day after Day.

i hope i have helped somone.

post 6 neural tension
 

hello everyone,
when i was being sent to various health professionals to be assessed they had various techniques for determining whether there was some sort of neural compromise in my right arm. a pt and later a neurosurgeon tried pulling my affected arm down and slightly behind my body to see if i felt anything strange. i did not. i had had days when i could feel pain in the nerve (i know there are three main ones) that run all the way from the end of my hand up my arm through my armpit and up the side of my neck. it was as though someone had a pair of pliers and was pulling the nerve down. this did not feel good. i believed that i was doing serious damage to the nerve.

when my problem was at its worst and I was resting on the floor laying with the chi ball between my shoulder blades (thoracic mobilization exercise or pec minor stretching exercise or as i like to call it long thoracic nerve decompromise) if i didnt use a pillow to support my head i could cause the nerve to feel tensioned, if i had my arm along side my body with my palm facing upwards. this was only with the chi ball between my shoulders. any more than 2or 3 secs felt quite dangerous. my unaffected arm could be positioned anywhere and i could not make the same symptoms happen in that arm . a visit to an insurance doctor showed me what the earlier medical practitioners were trying to do but had been unsuccessful. he pulled my arm slightly forward and down. the nerve felt as though someone was dragging the it out.

in the time that i spent sleeping on the floor (i had less head and neck aches if i slept on the floor) i would often wake up. in the early hours of one morning I put the chi ball between my shoulders as i often did during the day and noticed that there was a difference. i could place my arm next to my body with my palm upwards and the tension was not on the nerve. when i woke up later in the morning and once again there was no tension. frequent testing showed the tension to arrive at between 9 and 10 am most days

quite obviously the tension on the nerve was changing during the course of the day
also changing during the course of the day
pain in my hand and arm
manual dexterity
tingling in my r fingers
pain near my r shoulder blade
scapular stability

when i was not using my arm during the night, the tension on the nerve would eventually release.
when i used my arm during the course of the day the tension would come back.

since my injury, every time i lay on the side of my affected arm, strange sensations down my arm would start. since my r shoulder girdle has been weakened it was as though that side was not strong enough to protect the nerves from being crushed in my armpit. i could either affect the nerve by laying on that side or during the course of the day as muscles became tight
(I was told on a few occasions by PTs and a musculoskeletal doctor that my r pec muscle was tight)

since my condition has improved i cant make the nerve feel tight, i tried it again tonight
see you later regards towelhorse

post 7 bandsaw
 

hi everyone,
8 months into my injury i had been diagnosed with a c5/6 disc bulge and the orthopeadic surgeon had suggested that i have traction on my neck. he organised for the physiotherapist who was treating me to set up a traction kit at my home. i wasn't going to work now because the symptoms were getting worse. i performed the traction religiously. but it did not make me any better at all. it made my neck more sore. i was sent to a professor of neurosurgery. he said that the orthopeadic surgeon had read the MRI backwards. he said that if the c5/6 disc bulge was my problem the symptoms should be on my left side. he said he would write to the orthopeadic surgeon to tell him this. i told the professor of neurosurgery that a treating pt had told me that i had TOS. he told me that TOS was rare and only happened in people with an extra rib. he suggested that i could have a myelogram (an injection of radioactive dye into the spinal column) to see if it was anything to do with the c5/6 disc bulge. i declined, i didnt understand the logic.

i am very interested in cabinetmaking, i had been to night school for 7 years and had studied woodmachining, furniture finishing (french polishing), upholstery. advanced cab making etc. i have an extensive workshop at home. whilst not at work i had many hours to kill. i wanted to do my cabinet making but it made my shoulder worse. i have a radial arm saw. the blade on a radial arm saw "climb cuts" (as you pull the carriage out, the rotation of the blade encourages the carriage to be pulled out even more). using this saw would cause extreme problems. i had told the doctors that using my arm made my symptoms worse.
i needed to cut a small piece of wood. i decided to use the bandsaw. i was aware that if my hand was "misbehaving" that i was taking a risk. i stood in front of the band saw and without even using or even lifting my hand up it started to tingle. this blew me away. i didnt even have to use my arm to make it worse, i only had to think about using it. this is a difficult thing to tell your treating doctor especially if you are expecting them to be supportive of your condition being a physical one rather than a mental one.
months later and my treating doctor had retired and i was seeing a different doctor from the same practice. i had had a pt tell me that when i lay on my back my r shoulder was 2 inches further away from the table than my left one, she had told me that when i put my arms straight up in the air my left shoulder was good put my r shoulder would sit next to my ear. the occupational physician had said that there was nothing wrong with my shoulder at all, weird stuff because i coudnt lay on that side for more than about 20 seconds without it becoming too painful.

one day i worked out that if i rotated my r shoulder blade in a certain way (causing a grating sensation against my ribs) i could make the inside of my r forearm numb. if i did more rotations other symptoms in my hand would occur. if i continued i could make the inside of my shoulder blade feel warm as though it was bleeding ( i understand that the blood would be the same temp) and eventually it would sting so much under my scapula that it was not possible to continue. i showed the new doctor this and he said ah! displaced scapula. this is after i had done about 6 months of gym work to try and improve trunkal stability. protestations of worsening symptoms were met with no pain no gain from the occupational physician. the new doctor told me that with if i put my r arm straight out in front of my body my r scapula went upwards and outwards when it should not. months later i was still not able to control it as i should. a pt tried mirrors but i could not even notice the difference never mind stop it happening. she placed some tape across my affected shoulder blade. i went into the ajoining gym to do my other exercises.
i sat on the exercise bike and looked at the load settings. before i could move my arm i could feel pressure on the tape. i changed the settings and did my pedalling. when i had finished that i wet to the weights to do my light weight curls. before i could reach out to grab the bar i could feel the tape go tight again. evertime i needed to reach out infront of my body my shoulder blade would try and stabilize, but stabilize incorrectly, i didnt even have to e lift my arm just anticipate that i was going lift my arm. the penny dropped. when i stood in front of the band saw all i had done is stabilized my scapula (but stabilized incorrectly) this incorrect scapula stabilization was causing the nerve compromise.

grays anatomy says " the pectoralis minor assists the serratus anterior in drawing the scapula forwards around the chest wall. Acting with the levator scapulae and rhomboids.....
as my proper scapula stability lessened, with arm use my arm symptoms increased,
even when i only anticipated using my arm, if i did not have proper scapular stability i would get arm symptoms.

dr sanders has had great success with the pectoralis tenotomy. has anybody heard his explanation as to why the pec minor is causing compromise where we can only assume that prior to having a neck injury the sufferer did not have compromise under the pec minor. see yu later , towelhose

working out how to add a picture
 

i am trying to work out how to add a picture

post 8 "up on the roof"
 

I’ve spoken about how
1) My scapula stability varies (how heavy my arm feels)
2) The tension on my brachial plexus (BP) varies ( the pressure that the pec minor places on the BP, it increases during the day)
3) The strange sensations/symptoms in my arm vary

May I speak about how the muscles in my thoracic spine used to be in spasm in sympathy with these other problems?

After diagnoses of
• Cervical and thoracic spondylitis, which was changed to
• Thoracic spondylitis (the wry neck symptoms subsided but there was an excruciating pain on the rhs of my upper thoracic spine)
• Thoracic outlet syndrome
• C 5/6 Nerve root irritation ( later a neuro-surgeon told me that the orthopaedic surgeon had read the MRI backwards, the disc bulge was on the wrong side )
• Displaced scapula
• Brachial plexus syndrome
• Discogenic pain of the thoracic spine
There was a diagnosis of Myofascial pain of the erector spinae muscles.
The musculoskeletal doctor asked permission from the workcover authority to inject botox into muscles in my back. Strangely when I asked on 3 occasions into which muscle in my back was he going to inject the botox he would not tell me. His colleague said that I had T4 syndrome. T4 syndrome sounds like the RSD which I am reading of in other TOS sufferer’s stories. T4 syndrome is best described at this link
http://www.iaom-us.com/archive/newsl...9/n19-appl.htm
Please notice how they describe that sufferers often are awakened at night suffering symptoms when they are sleeping on their backs. Other activities such as driving a car or reading the newspaper often provoke symptoms. I read this as they are either lying on their scapula or stabilizing their scapula. also notice how they say that the symptoms are similar to TOS symptoms.

In 2004 our financial position (due to my injury) worsened to the point that we decided to sell our house. The house needed some painting to improve its condition. I was unable to paint some of the positions due to my condition, so I had to show my sons how and where. I have previously described how the tension on my brachial plexus increased as the day progressed ( due to decreasing scapular stability increasing pec minor tightness)
If I climbed on the roof which slopes at approximately 30 degrees early in the morning, I could traverse the roof easily without too much discomfort. If I tried later in the day, muscles in my back would go into spasm and would make it virtually impossible to climb around. I believe that pulling on the nerve in one area causes problems in other areas of ones body. Since my condition has improved and I can’t put tension on my BP I don’t have unexplainable pains in my other limbs. I was told that nerves slide in sheaths by PTs. They tried to show me how to do neural stretches. Unfortunately one of these made my condition significantly worse ( a whole heap of new symptoms such as cyanosis and cold hand) I think it is important not to stretch a nerve when it is trapped. The significance of neural tension became more apparent when I saw an article on the slump test.
http://members.optushome.com.au/physio/slump.html
I am sure that if one can stop the source of the problem, then so many of the other problems will go, if they try and fix problems later in the sequence of problems then there will just be another consequence to take its place.
I hope some of this may be helpful to someone. see you later , towelhorse

Up on the roof, the drifters 1963

When this old world starts getting me down
and people are just too much for me to face,
I climb way up to the top of the stair
and all my cares just drift right into space.
On the roof it's peaceful as can be
and there's a world below can't bother me.
Let me tell you now,
When I come home feeling tired and weak
I go up where the air is fresh and sweet.
I get away from the hustling crowd
and all that rat-race noise down in the street.
On the roof's the only place I know
where you just have to wish to make it so
let's go up on the roof.

thoracic outlet syndrome
 

Towelhorse
you are such a prolific writer...your piece gave me a lot of insight...I agree with you that NHS Doctors aren't diagnosing correctly (sorry bit of a sweeping statement). I too had to do my own research and become my own Specialist.

I was diagnosed with RSI 13 years ago - a compressed nerve in my spine, found by EMG tests done which found denervation and reinnervation in C7 root and mildly in C8.

I was then diagnosed with Arthritis and Fibromyalgia and basically told to learn to live with pain.

I undertook 2 years of Oesteopathy at the excellent European School of Oesteopathy in Maidstone - a teaching school so extremely cheap £5-10 visit. Then physio which helped but only 6 sessions allowed under NHS. Recently I have had Chiropractic treatment followed by more Oesteopathy.

I am still left with a right side which feels like I am unsticking sellotape on the inside, feel like my ribs are stuck. Its like I solidify if I don't keep moving and I have to "crack" myself to get my upper trunk in motion.

I can't fully lift my right arm without compensating with my ribs. I have been told by School Oesteo I have serratus anterior (problem?) and now I have internet - find this is linked with the long thoracic nerve which could explain the feeling of nerves rubbing like trying to light two sticks to make a fire! From this research it seems to be saying the major observation of Serratus Anterior probs is winging scapula (which I have). Would long thoracic nerve be same as thoracic outlet syndrome. If it is - the winging scapula would be your main giveaway. I can relate to heavy arms in early stages of RSI.

You mentioned about exercise with chinese ball inbetween shoulder blades - I use a wooden block in yoga and sit with it pressed on the wall....however...last time I did it I suffered with stiffness for next few days and I like the idea of something that can be altered to suit the person. Where can I get this? Everything in the public realm is made one size fits all - including chairs that are so big your feet can't find the ground.

It could be that you have cross-overs of syndromes, conditions, as I think you've said. You have asked a few points why...but don't want to lose this msg going back to them (new at this tech stuff ha!) but remember you said about sitting. We're told to sit straight but it doesn't work when your bodies out of balance and I think we sit instinctivity in a way to balance ourselves.

I think the main thing is follow yourself, your instincts, listen to your body.

I have tried this technique to help - use two hands. Cross arm in front of your body to opposite shoulder move fingers up halfway towards your ear. With other hand place it on same shoulder so that its like a cup handle.
Move fingers together and out again and together and out....gently stretching the skin and I imagine gently pulling nerve underneath.I found it amazing...and a few hours later I was just stretching out my arm in normal activity and I felt my nerve releasing (it actually felt like I'd been stabbed...I say that not to frighten you...but to illustrate the power of this stretch. From research it seems this is the area the thoracic nerve travels and it gets stuck on the sides of (things!?) and scapula. It is a very powerful release...I made it up myself so let me know if its any good.

From my research I have also learned I have Electrosensitivity which could have contributed to my RSI and I get tired if I am near too much electrical equipment. I am limited on computer, can't tolerate fluorescent lights, Mobiles completely wreck my head. It seems like damage to peripheral nerves could be linked with electrosensitity...that is my belief. It may explain your exhaustion - perhaps keep a diary of incidences of tiredness and note if you used the computer too much or lights or mobiles.

I hope that may have helped. I will come back to forum but need to limit my dose of electricity.
Be extremely interested to know if others with peripheral nerve injury, RSI have a sensitivity to electrical equipment.

Travel with Love
The Slug

Exercise to try
 

Oops just remembered with that technique you gotta also gently stretch your head and shoulder in opposite direction as though you are pulling apart whilst gently guiding this pulling apart with your fingers....you should feel a gentle tingle as in gentle massage as you do this try moving fingers to collarbone and over the shoulder always keeping in same direction i.e. towards ear and towards should - it should be pleasant and very gentle.

The Slug

hello Mighty slug,

I use one of those inflatable exercise balls to lay over 26 inch size - I also have a Styrofoam cylinder 6" diameter and 30" length approx. {a rolled up towel or 2 will work also}

nearly anything that is comfortable to lean on and over will work.

small firm balls will work for triggerpoint therapy. more info in our sticky -useful sites - above the posting list.

lay with that the length of your spine and let the shoulders drop down and also the chest will release and stretch.

do small movements with arms out at various angles for gentle stretches there too.

If pain is high start flat on floor with the small arm positions and movements.

diaphragmatic breathing is very good to use at this time also.

post 9
 

thanks for your info mighty slug. the chi ball that you asked about is only 5inches in diameter it is made of the same plastic that those exercise balls are made of. it is able to be inflated, deflated by removing a small stopper which looks like a golf tee and blowing it up to your suit your requirements. here it costs about 15 australian dollars. i worked out that just over half inflated was the best size, then at the local $2 shop they were selling childrens small soccer and basketballs (from china) just the same size complete with a small pump. so i bought a couple of those, pumped them up to just over half full and now i use those. my point about the relief that i get from laying on the chi ball is. I think that the chiros and PTs have misinterpreted the reason that some people get an improvement in symptoms. i dont think it is because the pec minor is stretched or the thoracic spine is mobilized. I think that there are a significant number of other people like myself who have scapula instability and when they lay on the ball they allow the nerve to be decompromised which improves scapular stability. when i returned to light duties (making security products) i would make my shoulder worse and very uncomfortable. i would attend a pt (we call them physio) session and lay on the ball 5 or 10 mins and notice the difference. then i would do some exercises, for instance a theratube arm exercise and lose the scapular stability.
using the chi ball decompressed the nerve, having to stabilize the scapula compressed the nerve.

one of the things that i couldn't understand with this condition was whereas if i had hurt my lower back or knee or some other part of my body is if i rested it would eventually get better but with this condition rest usually made it worse. i had told my doctor that i was having a terrible time sleeping so he prescribed some sleeping tablets. they would cause me sleep through the night but my symptoms would be worse. it reminded me of when my first child was born, he was a spilling all the time and vomitting. he would keep my wife and i up all night. we hadnt had a decent nights sleep for 12 weeks. we took him to the paediatrician and he prescribed a sedative for him. i was not happy giving a small baby a sedative but you assume that the experts know what they are doing. we gave him the sedative and he gave us some peace for a while but he was not happy when he woke up. we had a visit from a CAFHS nurse to see how we were going with our new baby. we told her the problem. she said try some antacid medicine (mylanta) he slept like a baby. we had been giving him sedation so the acid could eat away at his oesophagus.

i think it is similar with TOS when you are sleeping you are making your problem worse. you are compromising nerves. this is why sleeping is so difficult. the things which make this condition persist and worsen are
1. laying on your shoulders and ribs
2. using your affected arm (stabilizing the scapula)
3. chest breathing

it is pretty difficult not to do all of these things

thats why just resting doesn't make you better

within the next couple of days i shall take some pictures of the things that have made my condition significantly better.

i am interested if anyone has had a problem where they have
a)bent to the ground to pick something up
b)sneezed
and had the weirdest and scary sensation in their thoracic spine which feels as though their spine has opened up? when i was at my worst it happened at least ten times, once when the pt had her hand exactly where the clunk happened, i read of another TOS sufferer who described it. i will find the link for it tomorrow best wishes

sometimes I get the very strange sensation of the T/C or upper T spine feeling like it is pulling apart.

like reaching out over the couch to pull or push the large slider window open or closed. gotta get some silicone for this year so it will slide easy.

the leaning over to pull weeds of pick heavy objects from floor can at times cause this too.

One of my Dx's was cervico-thoracic spine strain with arm pain- this was from a physiatrist - his adv PT guy that actually did the full evaluation - {dr did not do it}- PT did find TOS sx - but dr did not change his Dx after the eval.

I think I do have both after doing kitchen remodeling project last summer, the spine strain seemed to appear again- lots of lifting, bending, carrying.

getting on yer nerves
 

Thank you Jo55 - the technique you describe sounds very similar to one I do at Yoga - basically lying on two yoga blocks lengthwise along head and spine with arms and scapula hanging over. I told my Yoga teacher your advice and she nodded enthusiastically - she said I need two sandbags on my shoulders to weigh them down.....have you tried this.

Towelhorse...I will try to help but please forgive me if my understanding of all these neurotalk is a little beyond me...and gets a bit scrambled up.

You say your point is - rather than nerves are being outstretched by laying on chi balls, relief is obtained because the nerve is decompressed which improves scapular instability.

This would concur with a piece I've found from a text book years ago and kept copies of.....I will try to scan at library and put on site but don't hold out too much hope as I'm not too good at these type of things....anyhow

The first thing would seem to identify the root cause of the instability it seems instability of scapular is caused by glenohumeral instability or rotorcuff instability.

I quote the following

"the tests are performed with the patient in suprine lying and involve passive movement into the 'apprehension test' position of 90degree abduction and 90deg of lateral rotation. In this position a gentle anteriorly directly pressure is applied to the head of the humerus. If the patient experiences marked apprehension with or without pain, then this is indicative of gross glenohumeral instability, as in the case of recurrent dislocations. Pain without apprehension could indicate either a primary impingement or mild anterior instability with secondary impingement.

Differentiation between anterior instability with secondary impingement from primary impingement is possible by performing the 'relocation test'. This simply entails positioning the patient in the above apprehension testing position and then placing a posteriorly directed force to the humeral head.

Patients with primary impingement experience no change in their pain level, while those with anterior instability and secondary impingement experience a lessening of their pain. This results from the posteriorly moving humeral head relieving the impinging pressure on the underside of the rotator cuff against the posterosuperior genoid rim".

It may be that you are both correct (not that I want to defend their point)
Sounds to me that pain is caused because of the rotator cuff pressing onto the genoid rim(?) and the chi ball perhaps changes the position of the humeral head which perhaps stretches the nerves and at the same time decompresses the nerve which pull apart the rotator cuff and genoid rim.
Or am I talking out my....:Ponder:

Its difficult to try to reason these things out when you don't have a clear picture of the parts e.g. what is a genoid rim, and I think you also need to see a visual demonstration of how things things move and function in relation to each other.

I hope that little piece may have helped:Scratch-Head:
It's so frustrating when people don't understand what you're trying to get at...I hope I haven't missed the point......If I have don't try harder to explain....I've gone down that road.....it means that I just don't and perhaps can't comprehend because of a lack of full knowledge on the subject. Perhaps someone outthere can supply the knowledge you need.

Take Care
I'd think about another occupation though if even light works are causing you a problem.....can you go on the sick? A job isn't worth ruining your health for....I learnt the hard way. i know its difficult wife & child to support.....

Travel with Love

The Slug

what made me worse /
 

hello every one,
apart from the frustration of having the condition one of the incredibly frustrating things was the blank looks one receives from treating professionals when you tell them of your symptoms.
for instance when my problem was at its worst if i tried to set a time on the microwave oven, if i pressed one of the buttons i would end up pressing it twice. if i tired to use a clutch pencil with a small lead in it i continually broke the lead. i couldnt write my signature properly. i couldnt pickup a sliced loaf bread without dropping it or crushing it. when i told the health professionals they would just look at me with a blank look on their faces. it is almost unbelievable that we dont have the expertise to understand why this is happening.

i tried to make up a flow chart of my theory of why i have the problem in publisher then converted it to word and then add it as an attachment but "the computer said no " those of you who watch little britain will no what i mean. so the i printed it and then scanned it but it think that it is going to be too small but i will have a go.

if you look at the boxes you will see that all i am doing is rearranging the order of how things occur. i am not intruducing anything new apart from suggesting that the scalenus medius ( one of the scalene muscles) is compromising the Long Thoracic Nerve (which will weaken the serratus anterior) rather than the scalene muscles compromising the brachial plexus.
i am only a pleb but i feel so strongly about this that i choose to stick my neck out.

here are some indicators of my varying scapular instability. if you try these be careful.
i can not put my affected arm behind my back and move it upwards without causing a lot of pain and worsening my scapular stability.
i can not put my affected arm behind my back with my palm facing away from my back and push my hand away from my back without causing a lot of pain and worsening my scapular stability enormously. ( an occ physician asked me to do this. the consequences were excruciating pain immediate loss of scapular stability, muscles in my shoulder twitching uncontrollably, he said that he had never seen a myofascial pain reaction like that before.
i can not hold things straight out in front of my body for very long without causing loss of scapular stability.
laying on my back without a support between my shoulders
if someone manipulates across a tight band along the levator scapula on the affected area.
maybe if the medical people treated TOS as a shoulder injury they might get better results see you later towelhorse

I'll try to save that image and see if I can resize it for reposting.
{ no -it gets too blurry}

Most of us have found that each of us has very different cause/effect when it come to TOS.
Specific PT, treatment, or other things might work for me but may not work for others.

It would be interesting if other feel they have more of the scapular instability like you have.

post 10
 

Hello everyone,
Ive spoken about varying scapular stability and also varying symptoms down my arm due to the varying pec minor tightness. I would now like to speak about other symptoms such as cold hand, cyanosis and changed breathing patterns.
The first time cyanosis was noticed in my affected hand was when my wife and I were at a meeting with a new rehabilitation consultant. The previous rehab con. had been dismissed by the case manager due to her improper conduct. A meeting had been convened to meet the new rehab consultant and also so I could express my disappointment with the Occupational Physician and his rehab strategies.
The Occ Phys had told me that despite the fact that the MRI indicating that the disc bulge was on my left side and it was my right arm was the affected side he still felt that my problem was nerve root irritation. His treatment consisted of a truncal stability program and neural stretches. The weight lifting in the gym caused muscles to become tighter and hand tingling to get worse. My complaints that my condition was worsening were met with “no pain , no gain”. The PT had written notes which I had delivered to the OCC PHYS which stated that I had scapular instability. The Occ Phys said my shoulder was fine. He instructed the pt to show me 3 neural stretches. These caused a massive flare up of all the symptoms.
At the meeting with the new rehab con. Where I was to tell her that I was getting worse, my wife (who is a nurse) said “look at your hand”. My right hand was blue /red, significantly different in colour to my left hand. The treatment that I had been receiving (for nerve root irritation) had worsened my condition. Not only did my hand become blue/red but at other times it would it would become significantly colder than my other hand. I often showed other people how much different the temperature of my hands might become. Before I was able to remove myself from the control of this Occ Phys he sent me back to my workplace . At the workplace I was required to use a machine which necessitated the use of my right arm above my head. Something happened in my upper back when I did this. I reported this occurring and I was given different duties. The strange thing was that when I sat down 10 mins later my hand turned cold. I have noticed that the over whelming majority of cold and cyanosis symptoms happen when I sit down. It would seem greater pressure on my diaphragm combined with chest breathing exacerbates these symptoms.
I have noticed that breathing patterns vary also. There is much information regarding TOS, T4 syndrome and chest breathing. I have noticed that when i lay down to sleep at night time that breathing becomes harder. I have mentioned previously that I use a brace to hold my shoulders down and back because this stops much of the muscle spasms which occur in my upper back. On a few occasions when I have removed the brace in the evening, it has been obvious that the chest breathing has started. I have also mentioned previously that investigations into high blood pressure had uncovered the fact that I have a hyper inflated chest cavity. An xray prior to my TOS problem did not indicate this problem. I have only had a breathing problem since getting TOS . Pulmicort has made my breathing easier. Sleeping is much easier when you are not chest breathing. It seems strange to me that even if TOS sufferers don’t have an extra rib they may have a section of rib removed (please correct me if I am wrong about this).
I believe that chest breathing is a significant contributing factor to TOS.
three PTs tried unsuccessfuly to retrain me to stop chest breathing, the medication has improved my significantly. the PTs tried the only way they knew how, if high blood pressure hadnt uncovered the chest problem, the chest problem would not have been addressed. got to go. see you later, towelhorse.

brace
 

thanks for the update towelhorse. any chance you can show us that brace you devised. i'm very curious but couldn't understand your prev. explanation very well.

"I have mentioned previously that I use a brace to hold my shoulders down and back because this stops much of the muscle spasms which occur in my upper back. "

I don't recall if you've tried the actual Edgelow breathing method exercises; you might find his video interesting. it shows breathing in both lying down and seated positions.

Oh I was looking for Sharon Butlers "tape trick" the other day.

Basically you have someone help you get into proper shoulder alignment and they place a large strip of medical type tape from upper back over the shoulder to the chest.
approx where the bra strap would be.

then throughout the day if you start to roll or slouch the shoulders the tape will tug and remind you to stay/get into correct alignment.

If you are in high pain or quite out of alignment start with tape in a better than your usual ,but less than the perfect alignment - and work your way up to the best.

1. I use a 6" in diameter and 3 foot long foam roller. You can get them online or in a "relax the back" store. It is great for all sorts of things (acupressure and the like). I lie on it lengthwise under my spine. Head is at one end, butt on the other. Legs bent...lower spine as flat as you can get (work that core) into the foam roller. Thus upper arms are draped over the foam roller. Yes, add weights to shoulder to open chest more and push shoulders back further. Try to engage RHOMBOIDS and MID-Traps to create this pull naturally. Remember to keep your neck straight do NOT pull it forward...head must touch foam roller.

2. I Yoga...I use a rolled up blanket...same principle.

!
Jo- here it is:


An Excerpt from Sharon Butler's Thoracic outlet syndrome treatment book:



The Tape Trick is a very simple and low cost way to find out if you are
unconsciously raising your shoulders and perpetually irritating the nerves,
muscles and connective tissues of your neck, shoulders and arms. Here’s
how to do it:

Go to the pharmacy and purchase a roll of non-stretchy bandage tape
that is 1/2 inch in width. Avoid paper tape as it tears too easily. Good old
fashioned bandage tape that is found on the metal roll is a great one to
choose. Tear off a piece that is 12 inches long. Now go find a friend to
help you.

The Tape Trick works best if you do it on one shoulder at a time. Pick the
side of your body that has the most severe symptoms of repetitive strain
injury. If you can’t tell which side is worse, then pick the side that is your
more dominant side. For right handers, that would be your right side.
Have the friend stand next to you, looking at your side. Remove your
shirt. Ladies, it is very important to slip your bra strap off of your
shoulder. Make sure that your shoulders are down and relaxed and that
you are looking straight ahead. Have your friend apply the tape to the
bare skin of your shoulder, in the same direction that a bra strap would
go, with half of the tape extending to the front onto your chest, and the
other half extending down your back onto the back of your shoulder. For
ladies it is important that the tape is not applied in the exact same area
where your bra strap lies because your body has become somewhat
unconscious to feeling pressure in that spot. Instead, have your friend
apply the tape about 1/2 inch closer to your neck.

Now your job is to get dressed and go about your normal daily activities.
If you raise your shoulders at all, the tape will pull on your skin, alerting
you to the fact that you are raising your shoulders. It is important to try
to recognize when and under what circumstances you are habitually
raising your shoulders. By recognizing when you are engaging in this
unconscious activity, you can choose to change it, and relieve your body
of untold amounts of unnecessary strain and compression.
Freely share this Tape Trick with all your friends and colleagues so they
can be on the road to less pain and stress too!

pictures and descriptions
 

hello everyone ,
I have attached some pictures of some of the things which have given me assistance to improve my condition. When I was at my worst I was laying down or resting for 18 hours a day suffering all the symptoms of TOS. Currently I am working 3 days a week at one place, I day at another, attending college I night and usually college I day. Previously evenings were terrible (as though I was recovering from an auto accident) now as long as I don’t do any thing dumb, they are really good.
I don’t know what order in which the pictures will appear.

Picture 1 chi ball, deflatable to suit the user, you can see the stopper. The size is critical it must fit between your scapula. I use it to take pressure off of the nerve that goes under the scapula. not for pec minor stretches or chest wall stretches. Any similar sized partly inflated ball will suffice.

Picture 2 foam cylinder, I use this 1) all the time if I am sitting in a lounge chair, between my scapula so as to ensure that I do not push the affected scapula against the chest wall. 2) if I am laying on a soft mattress, once again it protects the scapula. 3) when in a car seat

Picture 3 ERGO Chair, sitting in this chair places less pressure on my diaphragm which in turn allows a cycle of breathing which places less pressure on the nerve which runs under my scapula. I take this to both my places of work and it gives me greater capacity to sit and use my arms out front of my body, for instance working on a computer. Since I have been using the pulmicort and my breathing pattern has changed I have a greater tolerance for a normal office chair, but I use the ERGO chair if it is available.

Picture 4 laptop table. Sitting at a desk and using a computer was impossible for more than 20 mins or so. Muscles would wind up in my upper back and arm symptoms would happen. 2 and a half years I was starting an OHS course where I needed to use a computer. I borrowed my brothers laptop (notebook) and found that I was able to use it in various positions. The table can be adjusted so that I can lay on my bed with a chi ball between my shoulders and operate the laptop comfortably.

Picture 5 singlet (vest) with a hard foam block sewn on, to wear when sleeping in bed. You may be able to see where it was originally taped on. The size and shape of the block would need to be adjusted to suit the user. The critical factor is, that it must protect the scapula from being pressed against the rib cage when asleep. I wake up with 95% less neck and head aches when I use this. Significantly when my wife bought a new lambswool underlay for our bed. I woke up with the neck ache, I had to increase the thickness of the block to ensure that the block was not being completely absorbed by the soft underlay and therefore not being effective.

Picture 6 and 7, hook of shoulder brace. Previously a professionally made shoulder brace had been supplied which made a small improvement to the muscle spasms in my upper back. I worked out that the critical factor was how much pressure down, not how much pressure back. The part of the professional brace which travelled from my lower back to my upper back was not made of elastic material therefore could not exert constant tension as I bent forwards and backwards. As soon as I made and used the style of brace displayed there was a reduction in upper back spasms. I wear the brace all the time apart from sleeping and showering. I have a few braces. The one displayed is 50mm or 2 inches wide. I tried making one from 3 inch wide elastic. It would not fit on top of my shoulder or alongside my scapula as it needs to. The hook with the black webbing attached was removed from a small pouch and then sewn to the elastic. The hook allows easy removal from a belt worn in trousers rather than feeding the elastic around the belt each time. I wear the elastic under my shirt. So that I can wear a shirt tucked into my pants I now wear a pair of short pants under my pants. The short pants have a horizontal strap at the back. The hook fits onto this strap.

Picture 8 (me wearing the black t shirt) the elastic strap is hooked onto my belt, the two legs travel upwards with a leg positioned either side of my neck. The two legs are stretched under each armpit, the elastic once again travels around to my back and then to the front where the two ends are fixed together using Velcro (hook and loop). The tension fore and aft can be adjusted by stretching more or less of the elastic from the back to the front and vice versa at the top where it travels past ones neck. The effectiveness of this brace is very much dependent on 3 things.
1) The width of the elastic
2) The tension of the elastic
3) The band must travel upwards close to the spine and not be on the scapula at all. I find myself often adjusting the top of strap closer to my neck and away from my scapula.

Picture 9 taping the point of the shoulder back. Modesty precluded this 50 year old man from modelling in this picture. I thank son of towelhorse for volunteering.
As you can see it is not the same as the tape trick. I believe I have described in an earlier post the circumstances in which a pt first used the tape on my shoulder.
The tape is 11/2 inches wide. It is strapping tape that sports people use. It does not stretch. In the picture I have shown the other tape which I had to use under the strapping tape to protect my skin from the strapping tapes effect on my skin.
I am to the point now where I have only used the tape for five days in the last 15 months. These5 days were due to a medical professionals intervention which caused a negative effect on my scapular stability.
The intention of the tape is not for one to be able to detect movement of the shoulder blade upwards (although as the day progresses one can feel more and less tension on the tape) the aim of the tape is to stop ones shoulder from moving too far forwards. When my shoulder was held back with tape, the symptoms in my hand were only approximately 5% of what I had without the tape. I believe this to be because when one moves the shoulder forwards the serratus anterior is supposed to be controlling the scapula with the pec minor. If the serratus anterior is weak then the pec minor has greater influence than it would normally have and therefore it compromises the nerves under it. Anyway that’s my theory and until someone can come up with a better one I am sticking to it.
I would normally wear the tape for up to 5 days. Please be careful of dermatitis.

My improvement has been slow but steady. Just as there were many factors which contributed to acquiring TOS there have many conditions and circumstances which have not allowed my body to get better. It has been as though there is a threshold through which one must pass before the body can heal. Wrong diagnosis, wrong treatment, reaction to medication, need to use ones arm, secondary conditions, family pressures have all made it very difficult. If my information can help anyone, it is wonderful.

I just remembered something. A treating PT had said that my lower trapezius was weak on my affected side. This she said, was why my scapula was moving upwards. Where as many lower trapezius exercises had been unsuccessful in retraining my scapula to stay down, within 1 day of taping my shoulder I was able to use my right arm without my scapula going up. But when I used my arm with my scapula down there was a clicking, grating sensation under my scapula. this was not good. ( I believe this to be snapping scapula syndrome)
It became quite obvious that my scapula was not moving up because the lower trapezius was weak but because using the lower trap. caused pain under the scapula.

Hence, why the brace pulling my shoulder down works. The brace pulling down my shoulder means the lower trap isn’t causing the problem I have just described.
Picture 10 pulmicort there is something very strange happening in the diagnoses of TOS. Many persons treating TOS suggest that to get better the TOS sufferer must learn to breathe abdominally as their chest breathing pattern is causing problems. But when you look for at the list of symptoms of TOS sufferers it doesn’t list chest breathing as a symptom. So they are suggesting treatment for something which they don’t list as a symptom. The breathing problem is a major contributing factor in the TOS problem. Mine has been solved with the pulmicort. Much time was spent by PTs trying to re-educate me on how to breathe properly. I have spoken before on how I don’t get as tired, the bed feels like a different bed, the gastro oesophageal reflux is a fraction of what it had become since getting TOS, my chest is not hyperinflated and I am not hurting the nerve under my scapula as easily as I could prior to taking the pulmicort. Good luck and goodnight. towelhorse

the other pictures
 

these are the other pictures. i was restricted to only 5 jpegs

TOS continuum
 

hello everyone,


this is the flow chart that I tried to display before.

[U]An existing theory of how neural compromise might happen down ones arm[

Forward neck posture
Or trauma to neck
Poor posture
v
v
v
stiff neck
Scalene muscle spasm
v
v
v
Brachial plexus compromise
v
v
v
Symptoms in hand
Heavy arm feeling
v
v
v
muscle imbalance in shoulder girdle
SERRATUS ANTERIOR
WEAKNESS



My theory of how neural compromise happens down my arm

Stiff neck
Scalene muscle spasm causes partial
compromise of long thoracic nerve
v
v
v
SERRATUS ANTERIOR WEAKNESS
Caused by long thoracic nerve compromise
Scapular instability
Resultant poor posture
v
v
v
Muscle imbalance
PEC MINOR SYNDROME
v
v
v
BRACHIAL PLEXUS COMPROMISE under pec Minor
v
v
v
Forward head posture
(To minimise pressure On BP ones head moves forward)




as you can see, all I have done is rearrange what are perceived as symptoms and made them causes, and vice versa

towelhorse,

It makes a lot of sense. I agree the head forward posture is an attempt to relieve the pain and pressure on the b.p., I never noticed it prior to my injury.
My TOS was a result of acute trauma (vaccine reaction), but I was pre-disposed by my body - short, so I've spent my entire life reaching above my head, thin, narrow chest and long neck, plus an "extra" scalene, scalene minimus, draped all over the brachial plexus and extra tight under the subclavian vein.

One of the first noticeable sx was a drooping right shoulder - the long thoracic nerve was affected, weakening the serratus anterior muscle dramatically. I've always felt if there was a way to lift the shoulder back to it's proper position, the nerve compression would be resolved. But other than strengthening exercises, which have only made me much worse, I haven't been able to figure out how to accomplish that. I have, at a neuro's suggestion, trained myself to carry that shoulder level with the left, but this in turn creates issues with muscle fatigue and additional trigger spots - but it does relieve the pain of the shoulder girdle's weight resting on the plexus. When I'm seated or in bed I try to relax the arm and prop it on pillows. It's sort of a Catch-22 situation.

One thing to remember early on in the process is when there are scalene muscle spasms, you are also going to get brachial plexus involvement (TOS) - you may not feel it that soon or see the symptoms as it can take a while to develop, but if the scalenes are irritated then the nerves of the brachial plexus will be affected as they pass among them (they should "glide" freely).
Sensory nerves are affected sooner than motor nerves.

Thanks for sharing - got me thinking!
beth

vulnerable time
 

hello everyone
When my symptoms were worse, evenings were bad. Muscles in my upper back would become very taught. If I was unable to avoid using my affected arm, the rhomboids where they insert into the thoracic spine would be really sore, rotator cuff muscles would be painful, muscles between ribs would be tight. I would go to bed hoping that there would be less pain in the morning. But lying in bed would be uncomfortable too. The uncomfortable feeling lying in bed was hard to describe. If I lay on my affected side my arm would go to sleep, if I lie on my other side it would feel like my shoulder was going to pop out. If I lie on my back I would get a sore neck and head ache. But there was something else, there was a feeling that continuing to lie there was doing some damage to some nerves. On a few occasions I awoke and while I was in a state of semi consciousness I could feel a pulsing feeling in my upper chest on the affected side and slightly into my arm. I had had this same feeling when, in the weeks after first injuring myself and I was still fitting roller shutters, if I lifted the roller shutter up to my chest and I was about to lift it above my head to fit it into the guides I would feel a pulse, pulse, pulse in the space between my chest and my arm.

Back to the semi conscious state, it was strange because the pulsing feeling would disappear if I tried to move. It was similar to awakening and hearing oneself snoring for a second or two but then when conscious, you adjust something to stop snoring. It was the same with the pulsing, waking meant something changed and the pulsing disappeared

What I have worked out (in my situation ) is that there was a cycle. When I lie in bed at night I was compromising the nerve which goes under my scapula and therefore when I woke up in the morning I would often have less scapular stability than the previous night. Then I would need to use compensatory shoulder muscles to stabilize my scapula during the day. However these muscles were not made to stabilize my scapula in this way so they became very sore. So by the evening my upper back and rotator cuff would be painful, so it was a relief to go to bed, but I couldn’t sleep because even though I was resting the sore muscles I was now compromising the nerve under my shoulder blade again which meant that the compensatory muscles were going to be even more sore the next day. Just to make matters worse as part of my rehabilitation I was put onto a gym program to strengthen my shoulder girdle. I tried to tell the rehabilitators that I could make the situation better if I put my affected arm in a sling. They said this could lead to frozen shoulder. I don’t think that they had any appreciation of the direction in which they were taking me. They would only see me for an hour every couple of days. There were many hours of ygbbcjdujfbbn!!! In between those hours. When I told them that I was having difficulty sleeping at night (in the context of what I have just described) I was given sleeping tablets which of course allowed me to sleep through compromising the nerve which goes under my scapula which meant less scapular stability which meant even more sore compensatory muscles etc.etc.

I have worked out that
1) if I can minimise using my affected arm in the first few hours after waking up I will improve my scapular stability for the rest of the day.(if I use it, it compromises the nerve even more in another way {bowstringing}) these hours are the vulnerable hours.
2)if I didn’t have to sleep I would probably have not become worse like I did.
3)the sooner I but my shoulder brace on for the day the better I will be

best wishes, towelhorse

finding a way forward
 

In some of my earlier posts I have been critical of some of the aspects of my rehabilitation. Some of the reports of my condition have been outrageous. There has been a willing audience for the comments of this disingenuous swill. As a consequence of my injury being a work related injury, my integrity has been questioned regularly.

Much of the mental anguish that is suffered by injured workers is due to the fact that so much of their efforts are spent defending their credibility. After receiving dodgy reports, injured workers exhibit signs of distrust even with when they visit medical practitioners who will report truthfully.

The poor treatment of persons with conditions which are not completely understood guarantees an outcome that will be less than the optimum.

At my workplace a co-worker has developed asthma due to exposure to western red cedar wood dust. There has been much conjecture as to the validity of his claim. He has not kept his asthma under control. I could see how it might show that his claims were truthful to himself and to others if his breathlessness was evident. I could see it in my co-worker I wondered if I was exhibiting the same behaviour. I did things that perpetuated my condition.

Whereas it is completely understandable that someone with a disputed condition might behave in a defensive way, this behaviour is not conducive to getting better.
I found that I received a more welcome response to my comments of “feeling good when I wasn’t suffering from xyz symptoms” rather than saying “xyz symptoms are really bad”. This shouldn’t have to be the case, but it is the reality.
Somehow one has to break the cycle.
I wish you luck. Regards towelhorse

Yes - many here have and still are going thru the comp system.
The whole system stinks.
Denials right from the start.
Not even a few months of accepted and proper treatments with time off to try to heal.
Lying or just plain dumb IME Dr & reports.
Lazy comp attys that only want to get the $$% of a settlement and not do any real work for the claimant.
Plus-
So many of our own drs that won't admit that they don't know what the heck is really wrong with us - when they should just admit the don't know and refer us to someone that might know or try to learn about it.

:mad: :mad: :mad:
my vent about that!

whew

Use of Tape
 

I have found using tape a very helpful way of controlling pain by realigning my posture its hard not to depend on it

next post
 

I mentioned previously that my diagnoses have been
• Cervical and thoracic spondylitis, which was changed to
• Thoracic spondylitis (the wry neck symptoms subsided but there was an excruciating pain on the rhs of my upper thoracic spine)
• Thoracic outlet syndrome
• C 5/6 Nerve root irritation ( later a neuro-surgeon told me that the orthopaedic surgeon had read the MRI backwards, the disc bulge was on the wrong side )
• Displaced scapula
• Brachial plexus syndrome
• Discogenic pain of the thoracic spine
• Myofascial pain of the erector spinae muscles
• Chronic pain syndrome
• T4 syndrome
• Partial palsy of the long thoracic nerve

And that 1 neurosurgeon offered a myelogram that would lead to surgery on my spine, if they found something untoward and another neurosurgeon offered an operation where he would resect part of my scalene muscle but I was told that there was only a 30% success rate. And another doctor sought permission from the workcover authority to inject botox into muscles in my back.
It occurred to me that where I was consistent with the reporting of my symptoms and the actions which exacerbated the symptoms, the medical system was not consistent in its assessment of my condition and the interpretation of my symptoms. This led to much frustration. As you may have gathered I try to be specific, but the doctor’s reports ranged from “loquacious” to ”he describes some days as good days and some as bad days and can’t give any reason for the fluctuation”. I can assure you that I did give reasons for the fluctuations, and those reasons were “ when I use my affected arm I get tight muscles in my upper back and strange sensations in my arm, and when I put it in a sling it improves markedly.
For crying out loud the provocative tests for TOS are using the arm in ways that require extra scapular stability. Is this the biggest joke in medical history. Could TOS be caused by someone losing scapular stability and the symptoms are as a consequence of the other scapular stabilizers compromising the nerves that go down ones arm and the poor posture that they notice (after the event) is also due to poor scapula stability, and when they send someone on a shoulder girdle strengthening program they are only causing the other scapular stabilizers to cause more problems.


What if,
You went to the doctor limping and told him that you had sprained your ankle.
The doctor told you that your limping had caused the ankle sprain!!
You tell the doctor that as far as you can remember you weren’t limping prior to having the sprained ankle.
He told you that it was important to walk properly and that you should place your foot flat on the ground as you walk. You tell him that this hurts and you are not able to walk normally.
You tell him that you have a very sore ankle and that your job as a delivery person makes it worse. He sends you to a pt who has seen this condition before, she (sorry about the stereotyping) recommends a truncal strengthening program, corrective breathing exercises and 3 mile per day walk to improve your condition. She tells you to look on the internet to try and make some sense of it all. You see another doctor who tells you that the pain that you are feeling is all in your mind, its called chronic pain syndrome.

Meanwhile your ankle is getting worse, not better. You try and find another doctor and tell them that you have a sore ankle and now it seems also chronic pain syndrome. The new doctor tells you that they have heard that the condition can be caused by depression. You tell them that as far as you can remember you weren’t suffering from depression prior to hurting your ankle and ask them if there is anything that they can do for your ankle.
They tell you that there is an operation that can be performed on your knee that might stop the pain.
You insist that it is your ankle that is sore but now you don’t know what to do. The pain is really bad