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.

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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!