TOS or Something Else? Need Guidance
 

Thanks in advance for thoughts based on my history and MRI results below!

ME:
- 49 Years Old
- Played Golf/Hockey/Soccer since age 11.... notable head to goalpost hit roughly 2006... felt neck pain for a while, but seemed ok at the time
- Spend a lot of time with hand on my PC mouse, bad posture staring at monitor

START OF SYMPTOMS- Roughly Jan 25 2014, woke up one day with numb index finger... played golf (actually played well!). When didn't get better (in fact started feeling more pain in shoulder, burning under arm, numb index finger), saw massage therapist (~2/10), chiropractor (~2/16), and then PT (~2/24) and wound up getting MRI last Sunday (3/2). Have tried Aleve and Meloxicam but neither seemed to do the trick really.

MRI FINDINGS:
The cervical spine demonstrates normal alignment.Vertebral bodies are normal in height. There is a normal marrow signal pattern. Intervertebral discs demonstrate varying degrees of decreased T2 signal in keeping with overall mild multilevel degenerative change.. Varying degrees of facet and uncinate arthropathy present. The cervical spinal cord is normal in signal intensity. The craniocervical junction is normal. The included intracranial structures are grossly normal. The paraspinal soft tissues are normal.

Evaluation of the individual levels demonstrates:

C2-3: No disc protrusion, neural foraminal or central spinal stenosis.

C3-4: Disc osteophyte complex, asymmetric to right, slightly effacing thecal
sac, no neural foraminal or central spinal stenosis.

C4-5: Disc osteophyte complex slightly effacing thecal sac, no neural foraminal or central spinal stenosis.

C5-6: Disc osteophyte complex asymmetric to left effacing thecal sac, no right and slight left neural foraminal narrowing, no central spinal stenosis.

C6-7: Disc osteophyte complex, asymmetric to right slightly effacing thecal sac, slight right and mild left neural foraminal narrowing, no central spinal stenosis.

==================================================
PT person gave me a good "Treat your own neck" (McKenzie) book that has many good stretches I've tried... but when I push down/ back on my chin, I feel the numb/burn in finger and under my arm so I backed off that. Moist heat followed by some stretches and then ice seemed to help a lot today, so that's my current mode.. do that a few times each day. Actually felt decent around 11 AM today, but now some more burning under arm again tonight.

================= CALL FROM DOCTOR TODAY ==============
"I looked at your MRI and I think there is a chance that you have TOS so I'd like to give you Gabapentin and do some more PT". I took my first gabepentin tonight.
=================================

Questions for you guys:
1) Based on MRI above, what do you think? TOS? I thought TOS symptom was numb in pinky as opposed to index finger.
2) What sort of PT should I pursue?
3) Is gabapentin a good choice for med? When will I know if it works
4) Could this likely be fixed (slowly) by fixing my desk posture, doing PT and etc. Problem is when I lean way back in my chair and reach out with my hand as if to reach a mouse, I feel the pain under arm and into index finger now!
5) Any other tips/ guidance?

Thanks in advance.

Mike

Sounds like tos, I'm sorry.

Are you a MD?

If so, could you answer my questions?

Thanks.. struggling to figure out my next steps and woke up VERY dizzy on this med they gave me!

Mike

My latest bout of TOS had me with numbness/tingling in my left index finger. Burning pain is also a classic sign.

Take a peek at my thread. I've recently gotten myself out of this via serious deep tissue massage and resistance training.

KY

No MDs here that I am aware of...
You do have some possible co factors with the c spine issues. The chiro & your doctors should be of help with that part of it.. You could also post on our Spinal forum for more MRI & spinal questions.
Does DC & PT know about the MRI report info?

C3-4: Disc osteophyte complex, asymmetric to right, slightly effacing thecal
sac,
C4-5: Disc osteophyte complex slightly effacing thecal sac

C5-6: Disc osteophyte complex asymmetric to left effacing thecal sac, no right and slight left neural foraminal narrowing, no central spinal stenosis.

C6-7: Disc osteophyte complex, asymmetric to right slightly effacing thecal sac, slight right and mild left neural foraminal narrowing, no central spinal stenosis.


[4) Could this likely be fixed (slowly) by fixing my desk posture, doing PT and etc. Problem is when I lean way back in my chair and reach out with my hand as if to reach a mouse, I feel the pain under arm and into index finger now!]

YES..:) Armpit area pain?? This sounds like it could be pec minor tightness or even lymph glands clogged up.. is there puffiness and tenderness in the arm pit?

these things are simple and should be of help for posture, getting the shoulders & head back in line with body.
http://neurotalk.psychcentral.com/album.php?albumid=422

also trigger point work
http://neurotalk.psychcentral.com/thread125577.html

What is your avg pain level?
about the RX meds, they may cover up/block the pain, but they do not fix anything.. and if the pain is covered up you may tend to do more activities that make you worse off in the long run.

If you can focus on the good TOS PT (some standard/generic PT is NOT the best for TOS) & home care/posture work & awareness..

check out all of our useful sticky threads

Not an MD. I think they probably lurk here though. :)

Does it hurt in your armpit? For me hurting deep in the armpit went away after the pec minor release. It does still hurt toward the back of my armpit.

Have you done pt? That is first step. Running is a good exercise or walking is a good exercise for tos. Avoid anything that will strengthen your pec major, pec minor, or scalene muscles. Work on strengthening the lower abs, back of neck, and rhomboids. Skip all other upper body strengthening exercises. Get massages, sit in hot tubs or warm pools or baths. Skelaxin is a good muscle relaxant that does not make me loopy. Don't sleep with your hands above your head ever again in your life, lol.

Ky, How do I look at your thread? I don't see a link to what you're referring to but I am very encouraged by your note regarding PT/ training/ massage solving your issue. I also have a neurology doc looking at my MRI today so I'm excited about that.
Thanks! Mike

Jo, this is GREAT.. thanks... funny you mention, I did pull a pec muscle as well but the pain I feel is more towards the back under my arm near my shoulder.. but I'll bet it's all related (hope so)

So you think "slightly effacing thecal sac" on several of those could be the issue?.. I hope so.. I'd like to get a good PT/ massage/ resistance training thing going to get this headed in the right direction! Sounds like it's doable if I get the right routine going.

Eight, thanks... hurts in my armpit a little if I ever try a foam roller down there with my arm extended. I do have many trigger points.. near my shoulder blade, outside of arm at top, etc and pressing on those seems to help. My current routine is warm heat followed by some stretching. I will resume PT formally since it sounds like that could really do the trick.

Off to find a way to strengthen lower abs, back of neck and rhomboids!

How did you do a "pec minor release"?

will get back to pt person asap.. like today!

under arm pain comes and goes.. typically toward back of armpit

how did you do a "pec minor release"

Off to go find a way to strengthen the areas you mentioned!

Eight, I tried "quick reply" but couldn't get it to work.

Thanks... I will work on that.. .pain under arm comes and goes and typically toward the back of armpit. I do moist heat and stretching that my PT person gave me (McKenzie book) and that seems to help.. I follow that with ice typically.

How do you do pec minor release?

I will work on those strengthening issues you mentioned and tie my hands to my waist when sleeping.. !.. lol

Is your daily pain bearable? Does it keep you from playing golf, working or your normal activities? If not, I'd be cautious about taking the Gabapentin, not because it's a bad drug, but then you may not be able to gauge if you're making improvements with PT.

The thing about TOS is there is no "normal" presentation. For me, it never entered my hands/arms until I did inappropriate PT. I had pain everywhere in my upper torso, except my hands/arms. Find a PT who is vary familiar with treating TOS. If something they give you to do aggravates your symptoms, proceed with caution or don't proceed. It's a beast that can't be treated with the "cookie cutter" PT approach.

I'm not a doctor either, but your symptoms could be due to trigger points, and treated with a resolution of those as well as postural improvements. Fingers crossed for you. I use to play golf before TOS, but I've only swung a club a few times since then. Last month, I parred with my mulligan ball on the one hole I played. It felt so good to be out there again. :D

There is also a Trigger Point Therapy Book by Claire Davies that is extremely informative and outlines pain referral patterns. There are many points under your armpit and underneath your scapula. I lay on a MELT foam roller to access some of those, but the best is to have a massage or PT lie you on your side and work on them that way.

I wish MD's lurked here because then they's learn something!

Most surgeons don't have time to "Lurk". The top TOS surgeons know way more than we do. If you know more about TOS than your surgeon run, don't walk. Finding practitioners for non-surgical TOS treatment is more of a challenge.

Here it is off of the front page:

http://neurotalk.psychcentral.com/thread199027.html

PM me if you like.

KY

Lot of people talking about a "pec minor release." This is a surgical procedure.

Another avenue to explore (which I did): Deep tissue pec minor massage.

Get a raquetball or a softball and put the ball between the wall and your body and do cross friction on your pec minor muscle. Do this in 3-4 locations along the path of pec minor. I usually did 30 strokes. Repeat several times per day.

There are several examples of this on youtube.

Once you release the pec minor in this way, allowing the shoulder to move back, you could then work on strengthening the rhomboids to get that shoulder back and down. All of this will help open up the thoracic area as well.

KY

I have recovered about 70% with PT and some medication. I take 20mgs of Pamelor per day for nerve pain.

At this point my dr thinks it's pretty the maximum improvement I can get the non surgical way and I tend to agree, I have reached a plateau with PT and chiro. Going forward is mainly maintenance, I take a muscle relaxant when I feel really tight and do my daily exercises. My dr told me I need to them for life. So I guess this is not going anywhere unfortunately. :cool:

Pec minor release is a surgery. It is the least invasive, but definitely not a cure all. The pec minor is cut to completely disable it, it sort of shrivels up and is absorbed by the body is my understanding. I think it's a fantastic surgery, I even think people with chronic poor posture should consider having it. Sometimes I feel like I want to slouch now, because I am tired, but I can't!

If your doctor thinks you have tos, you probably do. It's not the first thing that people come up with as an explanation for symptoms, it is usually the last.

Good news is that only about 30% of the people with tos ever need surgery according to the internets. Many of us here are those whom have had "Poor outcomes" or whom are "complicated cases" such as myself.

If you get massages, get deep tissue.

Upper plexus TOS
 

Numbness index finger can indicate compression of the upper plexus (C5, C6, C7). I had upper plexus ATOS on my left side with numb index finger and thumb. Right side was lower plexus TOS with numbness ulnar side of the arm and pinky finger.

Thanks.... I had someone new (ie more qualified to say the least) look at my MRI and they indicated "Right Foraminal Stenosis at c6/ c7 and I'm now scheduled for an injection this Friday that he feels will help this.

What is ATOS?

What did YOU do to alleviate the numbness? Wait it out? PT? or did you do an injection? or what else? Trying to determine the likelihood that an injection will fix this up for me for a while/ forever.

I guess everyone is "wired a little differently" and this occasional pain under my arm might also be a "projection" of the pain coming from the c6 / c7 issue?

Thanks.. any links to the youtube videos? I can't figure out how to PM you. Doesn't seem to be an option.

I am now scheduled for an injection in c6/c7 this friday. Trying the stretches and neck strengthening and posture fixes.

My primary symptom remains just 6 weeks of numbness in index / thumb and some soreness under my arm towards the back. I have trigger points for sure and can get them with a self massage bar which brings relieve sort of.

Can't help but think that hand on mouse/ bad posture over the years might have got a nerve all aggravated. Hope the shot helps.!

ATOS is arterial
VTOS is venous
NTOS is Nerve

disputed TOS is usually when not a clear cut option of the above, usually related more to past injuries or repetitive issues.

Hello! I had Arterial TOS on my left side. As I said there, upper plexus which is also a bit rare (arterial TOS is also relatively rare I heard). My case was hopeless. First of all, it was correctly diagnosed only after many years of different types of symptoms which progressed over time (I was basically born with this anomaly). I got botox injections every 3-4 months since 2007, this only made my TOS worse. By the time I had my diagnosis, PT could not save me anymore although I really tried it. It gave me bad flare ups. So, surgery was my only option, especially since it was arterial and I had many problems with blood circulation, heaviness of arm, even though most of the physicians I saw would not believe me. I had first rib resection and scalenectomy in Dec 2013. So far I am doing well. Most of the symptoms are gone. Nerve pain is still an issue but this terrible numbness is gone (have it very rarely, but nerve related). PT 2 x a week with just scar treatment. In a few months, I will be able to slowly do work out to get my strength back.

So just in case. I hope that the injections will work for you.

All the best!

According to the vascular surgeon we used, with Arterial TOS, PT does make it worse. The body naturally moves to a slumping position to help restore blood flow.

To the OP, I, too, wish you the best.

To Nelly: But, aren't you getting surgery soon?? What happened?

This is interesting.

First, I had a pec minor release, six months prior to any botox. With this I got feeling in the ring finger which stayed. I got feeling in the pinky and middle finger, but it faded. Forgot fingers felt so much prior to this.

When I got my anterior scalenes Botoxed, I got feeling back in my little finger, more in the ring finger, and middle finger. I got some feeling in the index finger and thumb, but it went away.

Six weeks after that I got the middle scalenes Botoxed. Then I got zinginging nerve sensation and some feeling back in the index ringer and thumb.

Does this mean one could determine if they have ATOS and/or ntos based on which fingers are numb?

I thought I just had ntos, but it turns out I have both.

Which muscle relaxant do you take? Are there any effective ones safe for long term use? I used Celexocib (antiinfllammatory) but its linked to several scary diseases when used constantly.