Thoracic outlet syndrome and shoulder tendonitis
 

Hello,
I am writing from Canada and I am a french speaking canadian so sorry for my mistakes while writing in english.
I had been diagnosed with a left neurogenic TOS in December 2011. I had done PT for a year before getting a surgery (rib resection, scalenectomy). Since surgery I am dealing with chronic pain and in March 2014 a Physiatrist diagnoses me with a left shoulder tendonitis and an impingement syndrome. For me it is obvious that the two conditions are related. I probably use my letf arm and shoulder 50% less than before TOS. At my insurance they are saying that the two conditions are not related. Does anyone had TOS and after got a Tendonitis and impingement syndrome?
Thank you very much

The two can without a doubt be related.

In my two previous bouts with TOS, on both the right and left side, shoulder impingement preceded the TOS. It makes sense if you think about it. Usually, a tight pec minor and weak rhomboids, lower traps will contribute towards impingement. The humeral head of the shoulder will be pulled forward out of the socket because of this. This will create less room in the thoracic outlet area. If you have extra cervical ribs (like me), you'll have even less space.

That's why I keep preaching the importance of keeping the pec minor loose, having a strong back, and keeping good posture. It's all connected.

That said, having shoulder impingement doesn't mean you're going to get TOS. It can be a key element.

KY

Mine started with the same experience. I had shoulder impingement that was misdiagnosed and was told it could easily be fixed with a subacromial decompression. It did not help. I tried to remain active as a tennis player but then my labrum tore and my rhomboids and lower trap detached from the scapula. I had all of that repaired but still had pain and numbness in the entire shoulder and scapular area. Neck pain soon followed and I was again misdiagnosed as herniated disc being root cause. Cervical fusion had no impact on removing the pain. Years later I was finally diagnosed TOS and had the rib & scalene removal. I finally experienced a few months of great relief only to have different pains in the same areas return.

IMO TOS is complicated but the sooner it is diagnosed the better chance you have to get better.

Well, I have TOS, but with no surgery. I have had tendonitis on multiple occasions and have had bursitis once. More work is being done by the tendon that designed, do it is easy to see how it COULD effect it, but it can't be said with certainty that it DID effect it.

KY do you have any suggestions for PT for TOS? You seem to have a very good idea about the mechanics. I am working with a PT right now and would appreciate any advise you can give. I have a weak back, bad posture and also TOS, probably bilateral induced by whiplash injury when I fell off of a bike.

Akash,

I've made many posts on what I've done in the past just in case I don't get it all here. Again, I've had two major flare ups over the last five years. One on my left side and another on the right. Both NTOS. I also ever cervical ribs.

This worked for me:

1) Stretching / Tissue Work:

* Pec Minor Tissue: Take a raquet ball and massage pec minor either against a wall or floor. Multiple times per day. Work this HARD. I'd also add in the doorway stretch post tissue work.
* Subclavius: Do the same.

It's my opinion that you have to loosen pec minor before you strengthen. That humeral head has to move back into its correct spot in the socket. Seems like "droopy shoulders" are a common trait of TOSers.

2) Strengthening

Now you need to strengthen your rhomboids, lower-mid traps, and lats to get that humeral head back and down:

* One arm cable rows on impacted side.
* External rotation with bands.
* Prone cobras for lower traps (google it)
* Lat pulldowns or straight arm lat pulldowns.
* "Face Pulls" for upper traps.
* Chin Tucks.

3) Posture

This one is tough. You can basically undo 1) and 2) above if you spend the rest of your day with horrible posture. There is a whole lot you can do here, but I'm going to continue pointing to this program that I think has changed my life:

www.foundationtraining.com

Not only does this help to fix your posture, but it incorporates many of the elements I've mentioned in 1) and 2) above. I'd really encourage everyone to investigate.

Feel free to PM me with any questions.

KY

Thanks KY, I am trying to get a streghthening program together from all the various pt's I've seen. Where can I find these exercises you are recommending? Thanks,JKL

If you go to youtube and just type in those exercise names there should be plenty of options.

KY

Thank you so much. I have read posts here which say strengthening programs are bad as they can further inflame and grow tissue over the entrapped nerves/blood vessels. Has this been your experience? Is there any way to reduce chances of this from occurring.

Also, what TOS symptoms did you have - ever since my accident (story here:
http://neurotalk.psychcentral.com/post1083419-246.html), my right trap seems to seize up at the slightest opportunity. I could live with the hand pain and burning (these are the most common symptoms i get through the day) but the above neck/shoulder thing is what is killing me, so to speak.

What is surprising me is that the TOS is worse on the left than the right, but it is the right that seems to have the shoulder/upper back/trap seize up. In fact, exactly where this guys hand is : http://www.abbeychiro.ie/wp-content/...ropractic2.jpg
When i told that to Drs here in India, they looked baffled, but the WUSTL website says its a common feature of NTOS.

Akash,

My symptoms:

* Right Side: Burning scapula pain, burning upper arm pain, sharp pain at the elbow, tingling in fingers.
* Left Side: Severe throbbing in my forearm, neck/upper trap pain.

As for PT causing more harm, I'd say a couple of things. First, these exercises would build muscular endurance and would not promote muscular growth. All of these exercises would have you doing 15-20 repetitions or doing static holds for anywhere from 30-60 seconds. This type of exercise will not "grow" the muscle. You have to lift heavier weights in a repetition range from 6-12 to promote hypertrophy.

I'd also say that exercise could cause inflammation or irritation in the early stages. I'd have to think that if those nerves are glued in due to too much compression, unsticking them will not be pleasant initially. That said, all of these exercises should increase the space in the thoracic outlet and increase the likelihood that your body can maintain that space longer term.

Now this all assumes that your anatomy has remained unchanged. I have cervical ribs, but there is no data that I have in hand (or from Dr. D) that says these ribs have changed since I was say, 18 years old. If that's the case, then there was something fundamentally wrong with the way I was moving as a human being over the past few years. These exercises attempt to improve that movement.

In your case, I see you had an accident. If your anatomy has drastically changed since this accident, my situation vs. yours is probably not apples to apples. I'm not saying these exercises wouldn't work, but I'd take a very cautious and measured approach towards PT.

KY