What does my doppler ultrasound results mean
 

Hi


i have recently been diagnosed with suspected Thoracic outlet syndrome for which I have been having symptoms for past 7 years. I had a doppler ultrasound the other day and results are as follows:

On right side the velocity of the subclavian artery was 88cm/s in neutral position with an increase to 226cm/s in flexion.
on left side the velocity in the subclavian artery was 127cm/s in neutral position and increased to 262cm/s in flexion.
Impression: Based on above criteria there is bilateral arterial compression


Should the velocity be about the same on the left and right in the neutral position. Does this indicate anything? ( difference of 39cm/s)
What exactly do the results this mean? Is this serious? Prior to privately getting this ultrasound done I was told to do extensive Physiotherapy. I have also 2 cervical ribs. My own doctor told me that physio could make problem worse and didnt recommend me doing any and to get back to consultant?

After i had ultrasound done I felt really dizzy and spaced out of it, my eyesight was funny and couldn't concentrate on anything.

Today I was at dentist and she did a filling in far left side of mouth. My head was twisted to left slightly and stayed in this position for about 20 minutes. Afterwards i felt so ill, dizzy and my whole body was shaking. Could this be due to compression?

So fed up no one can explain dizziness which realy upset me.

Any feedback would be appreciated.
Thanks
:confused:

No sure about your numbers- some of the other members that had that test might be able to help with those.

but found this on the R vs L differences-
[An interesting finding in our study is difference between right and left vertebral arteries in patients younger than 60 year old. We have showed that in young adults peak systolic velocity (PSV) and flow volume (FV) in left vertebral artery are significantly higher than right side. We think that this is because of anatomical difference of right and left vertebral arteries; in right side, subclavian artery originates from brachiocephalic artery but left subclavian artery directly originates from aorta, beside this branching angle of left vertebral artery from subclavian and also branching angle of left subclavian from aorta is more acute than same angles in right side. ]
http://www.cardiovascularultrasound.com/content/7/1/2

What kinds of things were they doing- or having you do, during the PT sessions?
weights or strengthening? stretches, or basic posture work?

Also sometimes the extra c ribs are small or only partial, unless it has been a lifelong problem, something has changed to make them cause the problems.

What kind of work do you do, or any previous upper body injuries, car accident, sports etc?

Hi

Thanks for your response. i was assaulted at work 7 years ago. I was working on notice board and was hit from behind on right shoulder/shoulder blade. Since then I have had shoulder pain on and off which has been getting worse the past 3 years. however I was also having severe weakness in my arms which i put down to graves disease which i was diagnosed with a year after work incident. The past 3 years i have numerous neurological symptoms. The main ones that are bothering me are;
dizziness
spaced out feeling
blurred vision
eye pain
feel like I am drunk
severe arm weakness
dropping things
clumsiness
unable to do fine motor tasks e.g putting key in lock, doing up zips on clothes

A new doctor eventually picked up on cervical ribs due to loss of pulse on arm elevation. i have not started any physio yet due to conflicting opinions by doctor and consultant( consultant did not see any problem with pulse)

So kindof confused. I am wondering now if doppler results is saying that I have arterial thoracic outlet compression. I am also wondering about what could be causing dizziness and eye problems.

Thanks
Marcia

It all sounds horribly so familiar.:(
Dizziness and eyes probs seem to be an issue for me, especially when my neck muscles are in spasm and tender.......compressing on vessels?????
Restricted blood flow????? I tend to focus on my breathing " belly breathing" when I encounter dizzy spells etc.
I would definitely recommend that you push to be seen by a physiotherapist!
It was because of a physio that TOS was suspected in my experience. Just today I have returned from my first physio appointment since I had my op ( first rib excision- V/ATOS). Almost straight away he picked up on the fact that my Rhomboid muscle in my shoulderblade is a culprit for alot of my pain in my shoulders, back and arms. One second of gentle pressure on this muscle sent my arms loppy.
They know their stuff and triggerpoints throughout the body. Try to see one for advice, exercise/stretching tips etc.
Relax and keep strong!!!!!!!!:winky:

More than one person on these forums has had dizziness caused by TOS. I believe that in at least two of those cases in the last year, people have reported that their doctor (probably vascular MD) told them that their subclavian artery (or arteries) were so backed up that their vertebral arteries had reduced or stopped blood flow as well. This sounds like you.

PT is tricky. Some PTs understand TOS and do good soft tissue work. Most do not.

From what I've read, it's fairly common for people with cervical ribs + ATOS to get the surgery to free up the circulation, plus any scar tissue or fibrous tissues resulting from your injury.

My own dizziness was resolved with highly skilled PT, diazepam for muscle relaxant, posture improvements and time. However, my source is RSI and chronic muscle tension, not injury, and I do not have cervical ribs. You may very well need something different than I needed.

HTH

Thanks so much for your reply. Did your doctor recommend the operation or was it following unsuccessful relief from symptoms using conservative methods first. My doctor feels that physio will not help as the cervical ribs arent going anywhere. how was your arterial thoracic outlet syndrome diagnosed. Did you have angiogram or doppler ultrasound.

i live in ireland and I get the sense that there have not been many thoracic operations over here and hence the reluctance to even consider this. However i dont feel that they are taking my symptoms seriously and they keep telling me dizziness has nothing to do woth TOS which is contary to what I am reading on web.

Thanks

Just wondering, how exactly does the diazepam work? Have you any side effect?

Thanks so much for reply. This site is such a great support. Do you think that I should be seen by vascular consultant with regards to my ultrasound results? I elected to get this test done myself due to dizziness and to show that there was definite compression of arteries as I was being told by own doctor that pulse disappeared on arm elevation while thoracic consultant did not find this and said there was no evidence of arterial compression. he immediately dismissed me when I metioned dizziness.
i really want to try physio but am concerned that due to arterial compression that I could in fact cause more damage without first removing these extra ribs??

So confused. I live in ireland and feel that the expertise is not here and that they will wait until there is serious unreverseable damage before considering surgery. I feel that over here it is not a preventative approach that is taken. I was not told how long to give the physio to see if there is relief from symptoms which is strange. Also I have rang a number of physios and some have never heard of cervical ribs and most have never dealt with TOS.

Thanks so much for your support.

Hi there, first of all.. hope you are well:winky:

Op was recommended by the surgeon due to thrombosis risk but ultimately the decision to go ahead was mine. Basically the risk of a thrombosis was enough said!!!!
My venous and arterial compression was picked up on both Doppler and Angiogram tests so as far as I was concerned action was needed to be taken.
However initially it was after a visit with a physiotherapist who did the Roo's and Adsen's test on me and picked up that I had the telltale " white hands"..... No bloodflow or radial pulse in various positions.
Can I just mention that prior to this appointment I had been backwards and forwards to my GP's who had made no connection what soever with my collection of symptoms that I had mentioned to him for over 5 years.:mad:
Unfortunately my TOS life is not over despite the op as I have ongoing issues with skeletalmuscular stuff in the thoracic region and neuro stuff too...... but on a positive note..... no arterial compression on my right side. It's just a bummer that I suffer venous compression on both sides, so eventually my left side will need doing.
At the moment I'm trying to concentrate on post op recouperation before undertaking another op. Obviously if I experience serious probs with my left side than I will get it done.... sharpish!
I do not have cervical ribs but my space there is still tight and needing freeing up. Apparently on my first op, everything was taken... the whole first rib and some extras. Technically my artery and vein on my left side should be laughing.......all that space!:cool:
Anyway..... regarding your doctors comments of TOS and dizziness not linking--------- Just show them this forum. Plenty of us can vouch for it!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Me personally..... I think that they are 100% wrong and ignorant to say that to you.:mad:
It's a VERY real connection.
Stick to your gun's when explaining your symptoms.... you know better than anyone what you are experiencing.:hug:
Test yourself, if you feel the mentioned symptoms like fatigue or get white hands than I suggest you see a Vascular consultant.
Do the Roo's test, click on the youtube link below.... apparently you should be able to pump your hands for 3 minutes ( I DON'T THINK SO! Not if TOS is in question)
Click on the image on the top left hand corner.
http://uk.video.search.yahoo.com/sea...ff&fr2=piv-web


BEST WISHES mcduane, keep strong!:winky:

Thanks so much, I feel a little better already through your support.

Your SO welcome.....I know where your coming from!
Relax as much as you can, hot baths, relaxation music, stretching, massages, meditation... whatever works for you. Just keep in mind that stress tenses the body making our symptoms worse. Take plenty of "me time":winky:

Thanks again
Will try. I am just so anxious about evrything I do at the minute as I dont know what the risks are. I have 5 children, 12, 5, 4, 3, and 19 months and consultant told me to try not to lift anything over 14 ilbs and to hold baby in left arm. However dopller ultrasound results as above would suggest arterial compression on left side as well. I am getting so frustrated with myself and kids when they want me to lift them. Do you remember the results of your ultrasound was the compression only on arm elevation positions or was there indicators that there was a problem in resting position as well. Also had your surgeon performed many of these operations before?

before I found out about this TOS and my 2 spare ribs as I call them I went to a neurologist who made me feel so bad and (on requesting copy of my file) basically wrote 5 kids - stress.

Sorry now I am just letting off steam.
on a positive note I actually hugged the new doctor who immediately suspected that I had cervical ribs.

thanks
Thanks again

You let off as much steam as possible!!!!!!!!!!!:winky:
Yeap, my compressions are in various positions. Unfortunately despite my op I'm still having issues with sleep. Both my hands still go numb at night????????????? Strangely more so on the operated side ( both pre and post op)? Not sure why, so that's why I'm due to undergo further testing, EMG ( nerve tests) aaaaaggggggaaaaaiiiinnnnnn!!!!!:confused:.
I understand fully how anxious the not knowing makes you feel. I also have gynae issues too and at the moment missing periods. RELAXATION is a must, sometimes you just have to give yourself that " timeout". Even if its just for 15 minutes.I know that I experience a certain degree of stress that aggrevates muscle tension but not enough to bring on vascular compression and such, Doc's just have to accept that sometimes there are things that they don't understand. Don't you just hate it when they play the stress card!!!!!! VERY FRUSTRATING!!!!!!!!!
I feel for you not being able to pick up your little ones:(. Try and compensate by plenty of cuddles and having the older kids help you out?????????
SORRY... I know that doesn't help.:hug:
Be easy on yourself...... as much as possible in "MUM" world:rolleyes:
Take care x

I don't know how you might feel about chiropractic care??
Since you got hit like that it could be a few things are out of proper alignment..
if the foundation is weak, the house will fall...or fail...

http://www.upcspine.com/self.htm
http://tos-syndrome.com/newpage12.htm


An expert and highly skilled one , also one with extra upper cervical adjustment training might be of help.
Also one with soft tissue skills.

Even if for a consult only - same for looking for expert/advanced PT people - get an evaluation first and see if they seem to be knowledgeable before committing to them.

Get a comprehensive evaluation - they should spend time asking about symptoms, helps/hurts, pain levels etc.
Then they should proceed to the physical assessment part, overall posture, ROM, strength assessments.

They may not know it as "TOS" but they should be aware of all the body parts affected when you describe the symptoms.

*most doctors just don't have the time or the skills to do a complete eval..*


post # 1 of the useful sticky thread - kind of a crash course and then more in the rest of the thread
http://neurotalk.psychcentral.com/post388-1.html

Your symptoms sound so familiar and I had trouble as well getting doctor to believe the symptoms were all related. The dizziness was really bad before my surgery and I always felt like I was going to pass out. Since the surgery, I still have dizziness, but I no longer feel like passing out. During compression of subclavian artery, my vertebral artery would stop flowing completely. I am still having issues with both side, and don't know which side is worse. I did not have cervical ribs, but did have 1st rib removed on left. I wish you the best of luck.

belated welcome
 

I just wanted to stop by and give you a belated Welcome. I am glad you found Neuro Talk. There will be some people here, that can help with the test you had and the numbers. You found a good group of people, who will talk to you any time you need to. I wish you all the best. ginnie

Thank you for your advice. Will go back and talk to my doctor after he gets to see my recent doppler ultrasound results. (he is away on holidays at the minute)

Thanks for your reply. Did you elect to have surgery or were you advised to have surgery. I believe from my doppler results that I do have arteial TOS and am very anxious that over time with repeated compression that I could end up with blod clot and be in serious trouble.
For instance immediately after the doppler ultrasound I felt so ill, I felt dizzy, spaced out and my eye sight was not clear. I had to lie down for the rest of the day.
Also at dentist 2 days ago and had to have fillling on left side and my head was slightly tilted to left for approximately 20 minutes and afterwards I felt really dizzy and both my arms wouldn't stop shaking and i felt totally spaced out of it. Really freaking me out now as up until the recent (1 month) when i found out about the cervical ribs and TOS I used to keep pushing myself physically ( 5 kids) despite the excrutiating weakness/pain in my arms. Now I am afraid to do anything as I feel that I could do seriuos damage as arteries are being compressed.

What test did you have done to show up the problems with your vertebral artery?

Thanks so much for your support

Thank you so much

The doctor order the techs to check them during the ultrasound. I went through the dizzy spaced out feeling for over 3months. I could not get off the couch. If I raised my arm or turned my head to right, it would get really bad. I had found vascular doctor on my own, thank god. I had one doc tell me he knew problem and not to go to any other doctors. I am so glad I did not listen to him. He was a very arrogant doctor. I totally understand what you are going through. I only have two kids, but I use to work 60hrs a week. I have been unable to work since April 2011.

Hey I noticed you said you were living in Ireland also.
I was fortunate enough to find a physio who noticed an elevated first rib within a minute.
This was after I had spent a week in hospital under "the top neurology tem' apparently!! Since then I have kept returning to the same physio when my arm kept "going" i.e weakness coldness, discolouration, tingling, numbness and PAIN!!!!! Unfortunately he told me that he could do no more for me and I should be referred to a consultant.
Since then I have had the world of tests done and I am under a very good vascular surgeon in a DIFFERENT hospital..he cannot believe the lack of treatment I received in the first hospital,, and that i was not even referred to a vascular surgeon! He finally diagnosed me with TOS but he does not believe it is vascular,,which I find it very hard to get my head around.
Would love to hear your story., its great to talk to someone who KNOWS exactly how frustrating this is..
Laura

hi Laura

Sorry I have not been on this site in a while. Trying to ignore this awful condition and keep going. However this week has been very bad. I have been having blurred vision in my right eye intermitently. Driving me crazy and not sure if related to TOS.
Anyway what results did you get that prompted a visit to vascular surgeon. What treatment has he suggested. I have recently started physio ( 2 weeks) and not sure if this is exasperating thing or not(my own doctor seemed to think physio could make worse).
Would love to swap tips with you especially cause you are trying to navigate the great Irish medical maze like myself.
Look forward to hearing from you.
Marcia

I wonder if the vision problem might be due to trigger points?
Check this interactive/clickable chart to locate possible TrPs-
http://www.pressurepointer.com/pain_reference_chart.htm
http://www.pressurepointer.com/Users1.htm

A thumb, fingers or small firm ball against the floor or wall works wonders..

I still get very watery eyes when my muscles tighten up.