Need help with Diagnosis
 

Hi everyone,

I am usually on the spinal forum, but I need help with a diagnosis of TOS.

A quick history on my situation:
I had an cervical fusion in March of this year (2011) C5, C6,C7 but even after almost 9 mths of recovery I am still suffering with nerve compression in my median nerve (wrist) & ulnar nerve (elbow), along with the very painful radiculapathy down my right hand, numbness/tingling in last 2 fingers, horrible pain in my scalene muscle, trap & shoulder, burning neck pain, clumsiness, hand weakness, no fine motor skills in my hand, etc...

I've been back to my neurosurgeon a couple times & mentioned TOS & it was dismissed, instead he said I have a double crush & offered to do an ulnar nerve transposition.

I see my neuro in 2 weeks for him to sign my functional abilities form to decide if I'm able to go back to work (I'm a graphic designer = lots of computer work). Currently I'm on worker's comp and they will want a diagnosis, not just "I'm still in horrible pain and can't do my job". So I really want help to make myself clear to my neuro.

Both my physiotherapist & massage therapist have told me I have TOS, and all my symptoms confirm that.

My questions: How should I approach this with my neurosurgeon to get him to give me a proper diagnosis of TOS when I see him next?
Is there a test I can ask for? What wording should I use?

He just keeps telling me my fusion looks good and the hardware is solid. He sent me for an EMG 2 months ago and it came back with mild compression of both ulnar & median nerve. What else is there for tests?

I really need a proper diagnosis to be able to ask my case manager at worker's comp for more time off or retraining in another area of work.

Help please!!
Thank you
Cathie

I think some specialists dont believe in tos, and you cannot convince them that it exists. This may be what you are dealing with. Have your GP refer you to someone who specializes in tos. Start doing some research in your area first.
Godspeed
Jay

Hi Cathie, sorry you are having a tough time, have you had an MRI since your surgery? My neuro had me have one 8 months after my 3 level fusion, it showed moderate foraminal narrowing due to vertebral body ostoephytes at three levels both sides, these bone spurs can produced symptoms quite similar to your ulnar nerve compression, may I ask how your PT and MT determine that you have TOS? After different tests that my neuro did, one being called The MacKinnon(I will confirm)he sent me to a cardiovascular and thoracic surgeon named Dr. Craig Pearce located on North Service Rd E. where he performed a doppler ultra sound along with the Mackinnon test and a couple others tests with my arms that he dx me with TOS. You may want to ask you PT to write out a report with his concerns to take to your neuro appt? Have you spoke with your family dr he may refer you to Dr.Pearce? I thought with workman comp it was your Dr that made the decision of the return to work thing? Take care!
Bunz

Hi Bunz,

Yes, it is my neuro that makes the decision about the return to work thing. I see him in 2 weeks. I will ask about Dr. Pearce, thank you. The PT & MT both said I have all the symptoms that confirm TOS, but a dr needs to make the final diagnosis. I haven't been formally tested for it, that's why I wanted to learn more before I see Dr. Jhawar on the 15th.

I"m still no where close to being better, hard time coping with pain during the days without going to work, so I don't think returning is an option for me right now. My hand is always numb, cold, tingling, painful, pain in the ulnar nerve area and my scalene muscles and traps hurt like a bad toothache 24/7. It's horrible. Don't seem to be making any progress. I have no fine motor control over my right hand, have to balance and steady on a pillow just to put eye makeup on. Ugh.

I wanted the diagnosis to be considered so I can get an extension on PT for it through WSIB. If I have it then it should be treated, without a diagnosis they only treat the injury listed with WSIB (as you know they are particular with everything).

Yes, I did have an MRI a few months ago, but they only looked at the hardware, and it never went to the T1 level only my C-spine.

Thanks for the information, I'm sure Dr. Jhawar has the similar knowledge and referrals as Dr. Shimisa, so I will discuss with him and if I don't get anywhere then I will ask my GP.

Take care,
Cathie