first p/t--is this norm?
 

Last week, EMG showed carpal tunnel, physiatrist also put TOS as diagnosis, though all she found was CP. I def has more pain in the shoulder, neck, underarm than even CP area.
So, I had my first p/t today and he had me lie down on back, breath in, while he pressed downward on my first rib--he said he wasn't trying to move it, just loosen. On both sides, he had me breath in and then out as he push down--hard to explain, hope some of you understand. It didn't hurt, just felt like a strong stretch. Is that normal?
I am having the usual flare up that I get by every afternoon--behind right shoulder blade, under arm burn, some front of shoulder burn, back of upper arm. I also get this weird neck thing all around that feelis like fire ants crawling.
OK, just trying to see if I'm on the road to healing...? He showed me some ways to sleep with pillows, sleep has gotten terrible the last few nights--I instinctively roll at some point from my side and in starts burning all over and wakes me.
Thanks for all the help,
khaki

Sounds like a pretty good PT person so far..

Checking and mobilizing the first rib, is what it sounds like to me.
My chiro, the adv PT guy & the PT teacher all did it a few different ways for me, but the idea is the same.

I hope he does check around for Trigger point also.

It was a multi pronged approach that worked for me.

reduce the spasms
resolve as many trigger points as possible
drop the top rib/s back into place


I did most of the posture work at home
but chiro adjustments really helped with the forward head/shoulders & the hump at the back of the neck area..

Thanks Jo*mar--I was hoping you'd reply-I feel WAY better hearing you say that. He did also try some trigger points and talked about doing more with that next time, and bringing in one of the other P/T to talk with me more on posture--thanks, I feel relieved that maybe I'm on the right track :)

The pain and PT you describe sounds like par for the course with TOS. The fact that you also have carpal tunnel is a complicating factor.

You must get the sleeping under control. I was once caught in the vicious cycle in which sleeping was making me worse each day. I started seeing a neurologist who's specialties include pain management and sleep disorders (I don't have sleep disorder...just pain). I suggest seeing a pain management doc and finding the right drug regimen. With this bad pain, it must be managed or else it just multiplies.

Now I start my mornings out feeling pretty good (especially after a long hot shower). Things still go downhill as the day progresses. But, it is hell when you wake up with excruciating pain and know it is only going to get worse. You must avoid this place.

In the past many with severe pain ( and post op) would end up sleeping in a good recliner or using many many pillows to prop & position the body.

After my first surgery, I found it necessary to sleep almost sitting up for the first few weeks. I stacked a bunch of pillows below me and put a rolled up blanket on either side of me, so that it would be much harder to roll over in my sleep. I am a "side sleeper", so it definitely was not comfortable, but certainly better than dealing with lots of pain the next morning.

Take care. :)

Pillows?
 

What is the best type of pillow to use? I love my down pillows I can make them pretty flat,but I've been waking up at night with bad pain in my trapezius muscles and heavy arm and hand. I usually end up using no pillow by the am.

Has anyone tried using a neck pillow? I tried one but I think it was too big.

We have a mix of pillows and when I was in pain I used all sorts of configurations, whatever worked best..
I have 2 sizes of the contour memory foam type now, small and medium, and I try the larger size and the smaller size curve/bump to see what fits best for me.

Some liked the long body pillows for propping/positioning the body.

I'm a light sleeper so none of the noisy pillows worked for me -
like the Styrofoam beads and the husk? or hull pillows. (buckwheat hull)

is worse after p/t norm?
 

one more question--first p/t was yesterday--today I feel worse, severe burning in chest (right side mostly) and behind rt shoulder blade--burning behind both arms.
i don't go again until next wed.

My PT sessions were always 2x a week for about 2 weeks then spaced out more as the symptoms resolved...:confused:
I think the first set might have even been 3 x a week.

And later when I started with chiropractor and was in severe spasms he had me come 3x a week till we got the spasms resolved.


*My first sets of PT were only focused on the hand, wrist, elbow, arm pain as it was a w comp claim and nothing beyond that was addressed.

Finally got sessions for chronic shoulder/neck strain later on and more of the rsi pain/sx resolved with PT on the neck & shoulders....
Soon after that was when I started to find info about TOS.


*** did PT say to be sure to drink lots of fluids, tx can cause toxins and crud to flush out of the clogged up system, and water helps to flush it out.
Also could be delayed pain due to the pT session and the movements. If it get really bad call the PT place and let them know you are in quite a bit of discomfort.
They may say to come in for some gentle modalities.
Did they do any heat, ultrasound or massage, or e stim before or after the rib mob work?

My PT session /and chiro all used heat, massage, e stim BEFORE doing any other therapy.
It softens & loosens the tissues so they release more easily. That is what they all told me and it made sense to me.
Often I would go home and use ice after the RSI ( hand/arms) PT sessions, but ice/cold didn't feel good at all for my neck/shoulder stuff.

thanks--the P/T wanted 2x/wk but i have a 6K deductible and pay $85 per visit, so I asked to space--also have young kids & hard to schedule.

Yesterday he tried to find trigger points--didn't really hit any, he did the rib mobilization, both sides, 3x each. But at the time, I wasn't all that "flared up". He'd ask if something hurt or felt better and I kept saying the pain is delayed, and would prob show up after the visit...it did.

I slept some better with the pillow set up, but the shoulder and chest pain started earlier than usual today--and the chest burn is more than ever. Also still get the cold hand, bluish tint to hand & feet. Last note--the only pain meds I do is 2 advil up to 2x/day--that's my choosing--I take other prescriptions and hate taking more.

I hear you on the meds, I try not to take em if I don't really need them.
Early on with my RSI/TOS injury I stupidly kept taking more and more while trying to survive at work. I'd take 2 IB at break with food , and then hr later 1 more then 2 hrs another so by the end of a 10 hr day I was totally over the daily amount. :(messed my tummy up I think, don't have a cast iron gut anymore....
When I finally got written off work , I stopped those darn things , plus PT was helping finally since I wasn't having to go to work also.

wowser a 6k deductible :eek: that's a big chunk.

does a heating pad help you or lying on the floor?

same here i was popping like 4 ibueprofen pills at a time. it messes with your gut and your abilitiy to absorb nutrients--bad!!

khakis, you are lucky, most of us have to go through a lot of bad pts to find a decent one

how severe can the chest pain be--don't want to think heart, i don't really--but no surgeries and no car wreck or anything for me--the burning chest has never been like this, new symptom--both arms are 2

call the PT and ask if this could be part of the delayed pain.
Is anyone there to listen to your heart and see if the beating sound normal?


But if it is really bad, I'd hate to tell you one thing and have it be something else, so if you get really concerned don't hesitate to go to doctor or even ER.
Others in the past did go to ER for chest pains , often it was not due to any actual heart issue.

But don't put off going in to ER if you really think you need to.
If nothing else it will possibly get you some pain relief med.

Calling and asking the PT person or place if this has ever happened before after rib mob might reassure you and let them know you had this result and they may need to move easier next time.
Can't hurt to give them a call. :cool:

When I had the severe spasms - it felt like my chest was vibrating internally and I felt the need to cough a lot.

I could feel my heart beating in my chest, but i didn't really have pain with mine.

The beating was regular and steady no thumps or skips so I just waited it out, mainly because I had read about others having similar and going to ER with no heart problem showing up.

have you tried heat or maybe ice -but ice will probably tighten up the muscles more and not help to relax it.


But I can't say enough- if you feel very bad it might be best to go to ER or doctor. Just for peace of mind.

beat is normal pulse in normal--just called p/t,he said he was pretty conservative--i had him ask another p/t there who said it couldbe related...this guy i saw is young,new to the grp and...i do have family heart issues but am 41 in good health other than hypothyroid and my pulse, breathing, beat seems usual.
i had read abt the chest pain in TOS, i thought,but had not had it (yet)--didn't expect it to be so bad--like skin is really on fire across the whole chest area

QUOTE=Jo*mar;871303]When I had the severe spasms - it felt like my chest was vibrating internally and I felt the need to cough a lot.

I could feel my heart beating in my chest, but i didn't really have pain with mine.

The beating was regular and steady no thumps or skips so I just waited it out, mainly because I had read about others having similar and going to ER with no heart problem showing up.

have you tried heat or maybe ice -but ice will probablmuscles more and not help to relax it.


But I can't say enough- if you feel very bad it might be best to go to ER or doctor. Just for peace of mind.[/QUOTE]

The bluish tint worries me. I still feel like you should consult a vascular expert to make sure there is nothing emergent developing.

I too get sore after pt. if the muscles are too tight it hurts worse afterwards. . I had 8 months of pt and chiro for cervical disk stenosis and it just made my TOS worse. My pt is very familiar with TOS and it still hurts after. She uses ultrasound sometimes. I just had botox and trigger pt injections and i am waiting to see if I can go back to pt and have better results. I also do acupucture also. I am holding off on strengthening until the muscle tightness goes away.

Does the blue tint (comes and goes), cold hand (affected side) always mean Vascular or arterial TOS? I have had an EMG that showed the carpal tunnel. With my bad insurance, I'm already at my max Dr visit limit, and so everything is out of pocket. I had no previous injury, just repetitive movements (computer, being a mom..) I have hypoT which was way undermed. at time of TOS onset--other than that, I'm healthy!
I know you all have to guide me cautiously--just wanting to be wise. The chest pain is much milder--it was like the same nerve pain I get behind my arms, but all across the chest--like on the skin, didn't feel heart-like.
Thanks all, sorry to be so helpless, but I appreciate all the help

something else that causes changing hand colors is http://en.wikipedia.org/wiki/Raynaud%27s_phenomenon

i have subclinical hypothyroidsm

My TSH had gotten to 9.75, my endo raised my meds, but in 15 yrs since diagnosis, it's never been above 3, we try to keep at1.


I don't have pain when it turns blue--and it never lasts long. Could it be related to the carpal tunnel?

[I don't have pain when it turns blue--and it never lasts long.]

I wonder if it is something position related?
Maybe make a note of when it happens and see if there is a certain hand or arm position that brings in on or relives it?

I've heard of cold hand w/carpal tunnel , but not much about blueness relating to it.
My dh had both carpal released in mid 80'sbut his was traumatic overuse - jack hammering concrete. but his only tingled, hurt, cold, went numb/asleep.

the 2 most recent times--today, when i put my CPT arm brace on, maybe the compression on my ulnar area was too much--I usually wear it at night fine.
Other time was a week ago, I was standing and arm was at side, it got bluish until I moved it around a bit. I have had it with feet at times too--before any TOS started--if I sat for a while

lucky duck! at least you have that under control

@khakis:

I learned over time that burning in the chest or shoulder blade meant a nerve was irritated or compressed. It was my chiro, who would pop a rib in and adjust my spine, that would make the burning go away. Unfortunately, I never found a way to treat it myself although it could resolve on its own after hours or days.

Re: PT, it works much better with diazepam which softens the muscle tone and reduces reactions to any manual adjustments whether PT or chiro. It is seriously worth consideration. I use 2mg 2 X per day.

I tried cutting back one week and the PT did not work as well. My body resisted too much. I believe that diazepam enhances PT and chiro treatments for TOS sufferers.

For me, a dark red hand meant my rib was elevated. I learned to shove it down myself and this helped correct it.

You can also experiment with propping the arm on a stack of pillows to take weight off the shoulder girdle. That has helped some people, including myself.

On a related note, some of us cannot leave the affected arm hanging on the side without having the symptoms increase. So it has to go in a pocket, on an arm rest, propped on top of the pocket opening, etc.

I don't know what the blue means. My colors are white with flat veins or dark reddish with bulging veins.

HTH

Hi Chroma, who is your chiro and what does diazepam do?

Mainly a relaxant, I think.

[Diazepam is used to relieve anxiety, muscle spasms, and seizures and to control agitation caused by alcohol withdrawal. Diazepam comes as a tablet, extended-release (long-acting) capsule, and concentrate (liquid) to take by mouth.]
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000556/

Valium is the brand name for Diazepam.
Ativan (Lorazepam) is a similar medication (Valium is longer acting).

These drugs seem to be effective for many of us with TOS when muscle relaxers become ineffective. The main benefit of Valium for me is that it helps me sleep through the night and prevents increased tension in the morning. I only got 3-4 hours of sleep on Zanaflex and Flexeril stopped helping me sleep altogether (Soma didn't work for me either). When I didn't sleep well, my tension would be worse in the morning.

this is all really helpful thank you. I had the chest burn again yesterday--and did find several journals actually relating TOS with chest wall pain. I go back to p/t on thursday, they are switching me to a dif person--despite the $, I'm going to work on getting in 2x/wk, all of you seem to agree on that & it makes sense.
My blue hand hasn't happened again--and it did seem positional as Jo*mar suggested.
Thanks everyone!

Conservative Treatments
 

Oh Okay I am familiar with Valium. i think it gives me an upset stomach. Amazing you are already typing nospam! Relafan is now working for me better than either the flexeril or mobic(meloxicam). Today I pick up a cream from a compounding pharmacy with nerontin, as well as mobic and a muscle relaxant as well. W'ell see. Each week I try something new. I tried A Trigger pt massage last week,got sore that evening, but it may have helped. Will try it again befor I commit to more treatments. it is expensive. I Also talked to Dr.Aufiero at Orthohealing about trying the neural Prolotherapy which she thinks may have better results than the radio frequency. She says to come in while I am in pain and I will be able to tell right away if it will help. After that it is several sessions not covered by insurance. The shoulder brace is helping alot too.

My main concern right now is my arm pain which hurts with use, as I have no chance of going back to work anytime soon if the arm pain continues. Joyce (my pt thinks I have better movement since the botox and trigger pt injections even though I still have Trapezius rhomboid and arm pain.) She started giving me streghthening exercises for my core.

All in All I am about 30% better than I was 2 months ago,but about the same as when it first started a 1 1/2 years ago. I am going to give it a little more time before I start looking into surgery. i see Dr. Jordan on Friday so I'll see what he thinks.

It did take me 2.5 years to get back to a semi normal life.
My TOS is now more of a mild low grade chronic thing with myofascial discomfort with extreme weather changes or if I do anything holding my arms over my head for more than a couple minutes

Much of the time was wasted due to work comp and the system. I really had no clue about this thing called TOS until 1 yr into it and started finding info about it. Some of the time was lost due to focusing PT only on the hands/arms vs the whole picture.. But that also was due to the wc rules and the rx'd PT.
:(

Others already covered diazepam. This was actually the first relaxant I tried on the advice of my DO. He likes to start with it because other relaxants can have stronger side effects.

My chiro was Dr. Paul Methot who works at both Healing Hands Wellness Center in Larchmont Village, Los Angeles and on Euclid St, Fullerton, CA (714-879-8992). I say "was" because I moved out of Los Angeles.

Thanks, is he knowlegdable about TOS? I am looking for a chiro as my pt is almost out with my insurance.

He is, but I did not get full resolution. Then again I didn't get full resolution from my PT, meds or anything else. I'm a chronic case.

I would definitely give him 3 - 4 sessions and see what you think.