Diagnostics: Doppler Ultrasound for TOS
 

I haven't seen that much about Doppler Ultrasound on this forum.

Has anyone had a Doppler Ultrasound to test for vascular TOS?
Does this test definitively diagnose or rule out vascular TOS?

It seems people talk more about MRA/MRV or other radiography to see arteries/veins.

For those that have vascular TOS, can you share how you got a definitive diagnosis?

I just got the test - it came back normal for the most part. Except that when i put my arms straight up, the blood flow to the hands is completely cut off. The doc says I definitely don't have vascular TOS - but b/c my blood flow gets cut off when my arm are straight up-- it indicates that my 'thoracic outlet space" is smaller and that I may have a predisposition for TOS...neurogenic TOS.

Does anyone have any input or experience they can share...about the Doppler? Would really appreciate it....

Anyone out there....??? Please help....

So, when my arms are straight up, the blood flow is completely cut off -- but the doctor says this is NOT vascular TOS, b/c blood flow is OK when arms are down or at shoulder height.
Does this sound right???

My hands are so painful and they get very very cold....

Do you have any swelling in arms? arm color changes?

My blood flow still stops when I raise my arms up.
There is a small % of population that is normal for them, and for whatever reason they don't get TOS.

I have mild symptoms now, more myofascial discomfort than anything.
My worst times were in 03-05, from multiple RSIs & shoulder strains that became TOS due to many years repetitive work combined with static postures.

Early on I had sharp hand cramps, loss of fine finger coordination, wrist pain from tight/spasms-ed muscles, forearm pain, elbow pain & hypersensitivity, neck pain, shoulder pain, upper back pain, I think that covers it..

Found expert therapy/chiro, off work, lots of self care /posture stuff..took quite awhile to get beyond having to be careful of activities.

There is also a "disputed" TOS - if no clear nerve or vascular cause fits.

I feel it is very possible to have some nerve and some vascular symptoms , and not enough to be clear cut for one or the other label.
poor posture, spasms and trigger points can affect the nerves and the blood flow in the area.

Thanks for your reply.
So - according to what you said-- having your blood flow stop when your arms are directly overhead -- is NOT a definitive sign of TOS. Thanks - its good to hear it again from someone else. Unfortunately, I need to hear things multiple times from multiple different people before I start to believe it... for better or for worse at this point. :)

Some doctors think i have TOS and others are not convinced.... I am also not so sure what to think either.
I don't have visible swelling or color changes. I have some left shoulder/neck pain and then some really extreme pain in both hands And, on my right side, the only think that hurts is my hand/wrist area. I also don't have any numbess or tingling but have found my hands to get very cold... I was exercising the other day and while the rest of my body was hot and sweating, my hands were ice cold.

So - have you had the doppler ultrasound test? Did you have it more than once? Did the test pick up any changes when you started to feel better?

thanks again for your reply.

In addition to TOS issues, I have to keep my pec major and pec minor muscles stretched. Otherwise, they tighten up so much that they interfere with the circulation in my arms. Well mostly my left side. I have only hints of TOS and pec problems on the right.

Some doctors call it "pec minor syndrome", but whatever, I just call it "tight pec minors".

You can search these forums and the web for various stretches.

Getting this straightened out provided a major improvement for me.

Now if I could get my scalenes fully under control, I would be sitting pretty!

I had an ultrasound but I don't think it was doppler. It showed occlusion at various arm positions. The bigger issue is whether you are symptomatic, regardless of test results. Obviously, doctors like tests to confirm their diagnoses, but often that is not the case with TOS -- especially neurogenic TOS.

Has your doctor offered any other explanation for your symptoms and pain? More importantly, has your doctor suggested any treatment that might address your symptoms?

Have you had any expert PT or chiropractic?
How is your upper body posture?
forward head/rolled shoulders? hunched etc?
If so work on those and see if things improve for you.

Check out our sticky threads for more info on symptoms, testing & therapies.

Any previous sport injuries, whiplash, falls hits to upper body?
What do you think might have brought your sx on?

I didn't need any indepth testing as my symptoms did improve with good PT , DC and lots self care -plus off work..

My version is/was RSI based with a long time ago whiplash/concussion as a teenager, and lots of rough housing backyard sports as a kid.. had many falls, hits, bumps and such to make for some misalignment's that seemed to show up as I hit middle age + the repetitive fast paced job..and my type A competitive nature...

Sharon Butler's website , book & TOS program was very helpful for me - she has really good articles that explain the fascia connection..
http://www.selfcare4rsi.com/thoracic...-syndrome.html

I had a duplex ultrasound i think??

Normal. BUT i never saw the actual report, i need to

Fwiw i fixed my pec minors, they used to be gridlocked

Hey Gang -
thanks for all the replies...

I suspect my issues are from repetitive use and/or posture related. I didn't have a 'traumatic' accident or incident that I could tie this too.

While I have seen many 'expert' Physical therapists and chiropracters for ART and Trigger point stuff -- I haven't fully given the Edgelow Protocol a try. Since I am in the SF area, I am going to head over to Hayward and work with Edgelow's office and see what happens. Once I am established on the program, I will likely add in chroma's nect traction idea.

Thanks also for mentioning the Sharon Butler program -- I will keep that in mind for the future.

As of now, I just wish I had more diagnostic evidence to support a TOS diagnosis. My hand pain is extreme and its not falling into the typical 'numbness/tingling' complaint that might be more associated with TOS....

Anyway, thanks again for your replies and suggestions.

Cyclist,

I have more hand pain than numbness or tingling. I had some numbness in the pinky before surgery but only have in occasionally now. It's not bothersome. But I do have burning on the top of my hand, as well as pain in the knuckle of the forefinger and in the thumb pad. TOS presents in many different ways, which complicates diagnosis.

Take care,
Kelly

good to do edgelow
 

I did have the doppler ultrasound which showed profound postural changes. I have not had surgery and have been doing aggressive PT incorporating edgelow. a follow up doppler showed that I am not normal, but much improved.

Hi Iris,
thanks for your reply. When I did the doppler, they tested me in 3 positions: 1) arms down, 2) arms out at shoulder height, 3) arms straight up.

In positions 1 and 2 - I had perfect blood flow. In position 3 - blood flow was almost completely cut off. The doctor said that these results were normal and did not indicate a vascular TOS. The doctor said that the only thing it indicates is that I have a relatively small thoracic space...which might indicate a predisposition for neurogenic TOS.

When you had your Doppler ultrasound -- what positions were you tested in? And, after therapy, at what positions did you see the improved blood flow?

Thanks also for the encouraging words on Edgelow. My first appointment is next week.

Kelly - thanks for your reply.
Is your hand pain constant? or activity related?

My hand pain is rather constant AND intense (keeps me awake or wakes me in the middle of the night) -- and I would characterize it as deep ache, throbbing , somewhat cramp feeling. I really don't have any burning sensations, tingling or numbness. And, only just recently, I am starting to have weird temperature issues with it.

My doc recently suggested that while my left neck/shoulder/armpit issues might be TOS, he thinks its possible that the intense hand pain could be RSD. Has this ever been suggested to you? Have you ever looked into it?

A lot of my hand and arm pain diminished with physical therapy. I did Egoscue at home (search for that name and "pain free" on Amazon and check out the book reviews) and on-site PT later on.

I'm still left with a lot of neck and rib issues which have been really stubborn for me, but my hand is down to occasional mild pain and some twitching.

Good luck.

Cyclist,

My hand pain seems to be activity related, though it can come on very strong for no apparent reason.

My doctor, Jules Steimnitz in SF, has suggested that I have a version of CRPS, though I don't have the skin changes.

Feel free to PM me. I think we've probably encountered a lot of the same doctors. I am also considering contacting Edgelow's office. I tried the protocol in the past and never got past diaphramatic breathing. But I'm running out of options and feel like I need to try something.

Take care,
Kelly

I've had a doppler ultrasound and I'm very much like you. Good flow with arms down and at sides, but I want to say the other position was in a military press. I have no vascular symptoms and the surgeon rated it a 3 out of 10, but suggested I get my ribs removed.

I have (had) a bruit on the left side in military press position as well. I don't know if it's still there as I haven't succumbed to provocative testing in quite some time.

I don't consider it to be anything more than a point of data.

Anne4Tos - Thanks for contributing to the post. I agree with you -- this is just a data point and needs to be viewed within the entire context. I also seem to lose my pulse on various provocative 'tests' for TOS, like Adson's maneuver. A doc recently told me that 20% of the 'normal' population will have anatomy such that they lose their pulse in that position. In my opinion, this is far from being truly diagnostic.

KellySF - Thanks for the offer to chat more. Would be nice to compare notes on local docs. I will definitely PM you.

Chroma - I actually have the Peter Egoscue book, Pain Free at your PC. I got 2+ years ago, but at the time I was involved in a PT program that actively emphasized strengthening of the shoulder girdle. Since you have had success with it... I'll dig it out again and add some of the stretches to my evening routine...

Thanks All for the input!

the first time any time I had my arm in ANY position but down, the blood flow was cut off. months later, I was told that it was not normal, but much improved. I do the entire edgelow protocol.

Hi kelly
I was just wondering if ur burning in top hand started after ur surgery or before?
As woke up from surgery w my whole hand numb & burning fingertips vs just last 2 fingers numb bf surgery.
Thanks

I had a recent ultrasound. I have neurogenic TOS but new test shows in upright position bloood cuts off. I now have Vasculer too. I have both Neurogenic and Vasculer now along with carpal tunnel not to mention rotator cuff tear and herniated disc. Therapy is no help. Doe snayone else have symtoms of both?

I had the doppler ultrasound, which immediately showed blood flow restriction with arms at shoulder height. They also checked my vertebral artery which showed that when the subclavian artery was constricted, my vertebral artery would shout down completely. It caused major dizziness.

Hi - thanks for your post. What do you mean by "upright position" ? Are you referring to arms straight up?

btw- I think there a quite a few people on the forum with both neurogenic and vascular symptoms/diagnosis.

Tested for raising them, bith shoulders frozen and I can't raise above 90%