Clinical Tests / Diagnosis
 

I know TOS is often a diagnosis of exclusion with many times the diagnosis coming from one of many physical tests. Curious what tests doctors have done for you and what showed the most positive evaluation sign for TOS.

For instance I can do the "hands up" Roos test with discomfort but can go the full three minutes with only mild tingling present. I feel heaviness more in my shoulders than outright pain. For some this causes excruciating pain. When they depress my scalenes to recreate symptoms I am fine. I am told some are in horrible pain. Same with pec minor.

I ask because I am having trouble isolating where my entrapment exists and palpating the scalenes and pec minor (as of today anyway) do not recreate the symptoms. Anyone else fall into this category?

But seemingly my symptoms are getting worse with more burning and cramping in my forearms. So clearly there is unresolved compression somewhere. Just can't figure out where the problem area is.

Obviously it is harder to diagnose NTOS than vascular. Dynamic doppler ultrasounds are the quickest and least expensive imaging test (also no radiation). The best one I had done imaged my subclavian artery and vein and axillary artery and vein (the one that runs under pec minor) with arms up and down. This was done in both a lying down and sitting position. I also had an MRV and a CT done, but they didn't show anything the ultrasound couldn't pick up. Wish I'd saved myself the time, money, and radiation!

I also had the ultrasound done where they attach probes to the fingertips and had me move my arms above my head and out to the side while sitting up. This was strictly to test arterial compression.

EMGs are notoriously unreliable, unfortunately. From what I've heard from doctors and read on the boards, NTOS is really best diagnosed by symptoms.

As far as clinical tests, I've had strength tests done by both PTs and surgeons (I always fail the "hold your fingers splayed apart and don't let me push them together" test). Most docs have me put my elbows at 90 degrees with forearms up to 180 degrees and turn my head.

Needless to say, I've seen a lot of docs and a lot of PTs. They all rely on my symptamology as a guide in regards to nerve compression. I honestly thing a good PT is the best person to discuss where the compression is. Mine can tell me if it is coming from my rib/scalene area, scar tissue area, or pec minor depending on what she does.

But could you reproduce your symptoms?

Could it be triggerpoints causing some of those feelings?

When my sx show up forearms are the usual place, aside from the achy neck/shoulders stuff.

My forearms are lumpy & bumpy when I rub my hand slowly over the muscles, top is worse- knotty /ropey the PTs called them.

A little bit all the time but worse when I use them repetitively and when neck gets tight.

Been fixing my puter :( all day today so arms are starting to complain.
means extra home therapy time tomorrow.

Sorry to hear that Jo*mar, hope you dont flare, fixing computers sucks. Thank you for all your hard work and dedication here. I know everyone appriciates all you do.
Jay

Tough dx
 

It is tough to diagnose and everyone is different. My arm was purple and swollen with a deep itching in my chest, tingling pain in arm shoulder back neck, etc. all of my tests were normal. I was even given a diagnosis of mastitis, never mind the purple arm haha. I had MRI s, ultrasounds, horrible nerve tests, blood tests, etc. Neuro exam all NORMAL! the very last test, a venogram showed 75% mechanical occlusion of my subclavian vein. Find a doc that will stopatnothing to help you. Although rare, they are out there. Oh yeah make sure they do "dynamic"scans very important. Mine were always done with my arm down at my side, no good.

Where did you get your tests such as the dynamic doppler ultrasounds?

temp relief as dx help
 

I was diagnosed based on symptoms and nerve conduction studies, but what really confirmed the thoracic outlet as the place of compression...for my peace of mind anyhow...was opening up that space briefly and experiencing heavenly moments of relief. Before my surgery I was asked to complete 2 months of the Edgelow Protocol - a specialized physical therapy just for TOS. The protocol never produced lasting relief, but there was one part of the therapy I could do that would give me profound relief for a few brief moments...maybe you could try this one technique and see if it works for you.

• Lay on your back on carpeted floor with knees bent.
• Take some nice deep breaths to relax.
• Once you are a bit relaxed, begin arching your back as you breath in (visualize shortening your spine).
• As you breath out, flatten your back and really "pull" your rib cage down. I would dig in my heels and use my legs to physically pull my pelvis down and really pull the ribs down. Visualize that top rib coming down and opening up that thoracic space.

For me, doing this would bring total relief to my arms. As soon as I would breath in again and my ribs went back up, the symptoms would return, but this really helped me know for certain that the thoracic space was the area of compression.

Hope this helps you...and perhaps others.

Dynamic simply means that your arm is placed in different levels, especially above shoulder level. Example would be an MRI of the brachial plexus with arm down, at shoulder level and above the head, not just Laying in one position

dopper not for neurogenic??
 

I do believe doppler testing is only for veneous and arterial TOS, not the neurogenic variety??? I am correct?