Needing Advice
 

Hi everyone. I have had severe neck pain for the past 5 years. Have only just had MRI and diagnosed with bilateral cervical ribs. My symptoms are severe neck pain, shoulder pain, tingling and numbness in right arm, blue hands on and off, chronic fatigue syndrome, really bad headaches and chest pain. I have today been referred to a cardiothoracic surgeon (i think thats right) and they may operate. With my symptoms do I need surgery? Very scared about it but my pain is so bad, i cant live with it. Are my symptoms severe enough to have the surgery or not? TIA

Hi Mum...5? wow, I had 4.
alot of thought about the surgery answer. Did you have a second consult? C ribs are fairly straight forward, it is not like trying to fix a sick or injured nerve as in a car whiplash of other injury. Nerves do not grow healthy tissue. The c-bones under the collar bone removed in theory open the space where compression is.

If you have blue hands there seems to be vascular compression and that is a concern.
Surgery is generally a last resort and not a cure, but helps. Sometimes a lot, sometimes worse.

But a second opinon with a top doc that knows TOS is the best idea. He can do some dopplar testing and read the MRI, and try to see if there is another way to reduce the compression....back to the way it was 5 years ago before the flare.
Like putting it in remission.

May be every day activities are escalating the pain, and even if you have surgery and go back to the same activities, scar tissue may aggrivate.

There are 2 things to do, see another doc, try accomadations to your life, find a med that does help, reduce,......if not at least removing ribs will open the area.
BUT should be done by a doc that has done hundreds of this surgery, not a few in his life....
Just brain storming and chatting as if a family member asked me what I thought.
Is there something you are doing repetativly?
feel better
di

Hi Di,

Thanks for your reply. I would do anything to go back five years and be pain free again. I am seeing a cardiothoracic surgeon so I guess he will be my second opinion. I understand surgery is the last resort. I have tried pain meds, chiropractor...nearly killed me with the horrific pain and PT of which I have had no relief. Surgery for me sounds more and more appealing and yes I'm concerned about why my hands are blue and red, weird.

I was a fan of mt climbing but it aggrivated my symptoms.

I will update once I've had my appoint. Thanks

Oh yes, all that reaching up and out and the tension of holding your weight would be very taxing for xtra c rib & even most w/ TOS.

You might be wise to meet with at least 2 well rated surgeons & as Di mentions be sure to get an expert as lots of touchy things in the area of x c ribs.

But from what I have read over the years x c rib removal usually have the best outcomes as long as a qualified surgeon was used.

Having good after care & caution during recovery - some had re injury due to car accident or too quick reactions to try to catch things.

The ribs must be pressing on the vascular areas to cause the blue hands.
So that is an important reason for surgery too.

Have you found our sticky threads up above the main thread list?
- look for the green circle icons w/ arrow to find the sticky threads.
A Drs & PT thread - might be helpful for you and our Useful sticky has lots of all sorts of info, polls , videos

Hi Jo,

Thanks for your reply. Well I was refered to the cardiothoracic surgeon and had my appointment today. His registrar performed the Adsen Test and yes it was positive. I thought that meant I did have TOS? The surgeon told me that severe neck pain would not be associated with TOS normally and he has referred me on to a Neurosurgeon for further testing. He said I would most likely not benefit from surgery. I told him my hands are turning blue and Ive been having bad chest pain the last few weeks. He seems to think there may be something else causing the neck pain and not the bilateral ribs. I feel like I'm being given the run around and tossed to different specialists because I am most likely in the 'too hard' list. So I am waiting to see a neurosurgeon. Does anyone know what he might likely do? TIA.

Anyone have Internally rotated shoulders ?

Those positional tests help lean towards a possible dx, but 1 positive test alone doesn't prove it. They probably should do more of the positional tests as shown on this site - http://www.nismat.org/ptcor/thoracic_outlet/
As well as as taking a full history of your symptoms and any previous injuries, then decide if more in depth scans or tests are needed.

But many other things, like C spine injury, need to be ruled out & you can have multiple issues also, and that confuses the picture.

Have they done any Imaging/MRI yet ? sorry if I missed that .

Is that is the same as rolled forward?
Yes , somewhat , but i try to keep them back as much as possible.

This site describes tests for shoulder issues
The Five-Minute Shoulder Exam
http://www.usask.ca/cme/articles/fmse/index.php

Hi Jo
 

Hi Jo,

Yes they did an MRI which showed my ribs to be quite low which is why they don't think my neck pain is associated with the ribs. The MRI ruled out any abnormality with my discs also.
I am happy to see the neurosurgeon if it means ruling out any other nasties. I guess they are looking out for my best interests. I will keep you updated. Thanks for your reply. Suzy

Your symptoms sound a lot like mine Suzy.

The latest possible dx for my neck pain is a neuroma. I feel like there is a burning golf ball just to the left of the cervical thoracic junction. I'll be intersted to see what your full work up shows.

Good luck !