Tos
 

Hello everyone. I am new to this site. Let me start. In October of 2013, while I was working as a Police Officer I was pulled into a car window and the driver took off with me hanging out. He drug me for about 6-10 feet. I hit my right shoulder and neck on the pilar of the window. When I broken free the vehicle hit me on the right side. From this I sustained injuries. The first reports of course was just major bruising and deep tissue pulls. The doctors finally diagnosed me with a brachial plexus injury.

Moving forward I also had major damage to my right shoulder. I had rotator cuff surgery for the tears and damage. For my nerve damage I have had two injections. Neither injection has worked. Matter of fact really nothing has worked. For over a year now I have had the same pains, numbness, headaches and so forth. Finally, my neurologist sent me to see a vascular surgeon in Denver. The doctor read my file while we talked. He had me do some tests and concluded that I had TOS. He talked briefly about surgery and the complications of it. He then said that he wanted me to get a scalene minor pec block and then we would talk.

Ok, so I have had blocks and injections and they have not worked. Can anyone tell me their experience with a this kind of block. Also, I see many people have had the rib removal surgery and I see the obvious opinions about it. I just don't know. I will never be a cop again but I need at least a little relief if I can get it. I know that there are side effects and that things can get worse but I have to try. I have been in therapy for oh 106 visits now and I have been off work for over a year and on workers comp. I guess i just want to hear thoughts on the block and surgery and what the recovery times are after surgery? Sorry for rambling and thank you.

Welcome huntingful. :Wave-Hello:

What doctor did you see in Denver? A TOS surgeon like Brantigan or Annest?

Don't discount expert chiropractic care.
Being a cop can make for quite a few misalignment episodes.

If you can find one that has a low level laser, IF stim and does manual trigger point work or NIMMO and even upper cervical adjusting...it just might help a lot.
Go to a few top choices for evaluations & to get a sense of skills/knowledge.

useful sticky threads- mega crash course for TOS -
http://neurotalk.psychcentral.com/thread84.html

http://neurotalk.psychcentral.com/thread125577.html
http://neurotalk.psychcentral.com/thread135.html

Hello and Welcome!
 

I am so sorry this happened to you, Officer, and I am sure the others here join me in welcoming you and also thanking you for your years of service. TOS is not an easy thing to learn to live with, by any means.

You mention that, in addition to rotator cuff surgery for your shoulder injury, you've had two nerve injections. May I ask which nerves were injected, and whether the physician used imaging techniques to guide them, like ultrasound with fluoroscopy, for example?

Another question is, did the vascular surgeon who diagnosed you with TOS tell you what type of TOS you have, primarily? (Could be vascular, either arterial [ATOS] or venous [VTOS], or neurogenic [NTOS], so-called "disputed" or "non-disputed" form.) This makes a difference in what your chances are for a good outcome if you do decide to go forward with the first rib resection and/or scalenectomy surgery/s, as well as what type of treatment modalities you're likely to get the most success from.

Speaking from personal experience, as well as what I've been able to gather from the medical literature, the fact that you did not have a positive response to the scalene/pec minor block doesn't necessarily mean that you don't have TOS. Just another one of those confounding things about this crazy disorder!

I had a first rib resection with Dr. Annest in Denver about 9 years ago. Stayed in Denver for a few weeks afterwards, to take advantage of the excellent aftercare available there at that time (PT, OT). As luck would have it, I had an accident shortly after I returned home to Los Angeles, which compromised the results of that surgery, so in all honesty I can't say it did a whole lot for my pain levels, but hopefully it did arrest the ulnar nerve damage that had been causing my hand muscles to atrophy…

Whether or not to have TOS surgery is a tough choice, and should be considered only as a last resort for most of us (unless your case is severe, vascular or true neurogenic, in which case the options are fewer).

There are other, less invasive or non-invasive measures you could try before surgery. I know you've already been through a lot of physical therapy (and are probably sick of it!), but I'm thinking that most of it was probably before your TOS diagnosis. TOS does not respond well to traditional forms of PT: strengthening exercises, Theraband, upper body machines, cervical traction, that whole "no pain, no gain" mindset. In fact, traditional PT can make you even worse!

There is a specific protocol for use with TOS clients which very few PT's are trained in, that incorporates rebalancing certain muscles, addressing trigger points and correcting postural issues and respiratory dysfunction, etc. BEFORE any strengthening begins. I don't claim to be an expert by any means, but there are lots of folks on here who are extremely knowledgable about this. And if it was Dr. Brantigan or Dr. Annest whom you consulted with in Denver, they might be able to hook you up as well. You would definitely need a TOS-savvy PT, before and/or after any TOS surgery/s.

Another procedure which like the scalene/pec minor block, can help to diagnose TOS, but which is also used therapeutically as it can offer months of relief from painful symptoms, involves Botox injections into the so-called "culprit" muscles (anterior scalene, subclavius, pec minor). This is often done in conjunction with a course of PT, in order to see if your symptoms can be managed non-surgically. (At the same time, your body's response to the Botox injections can provide some useful information to your surgeon as to your candidacy for successful TOS surgery.)

Then there's also bodywork, not generally covered by medical insurance (not sure about Workers Comp), but many TOSers find it very helpful: Feldenkreis workers, Hellerworkers, etc. Lots of different techniques. And chiropractic, as Jo mentioned, has been helpful for many.

Each TOS case is different and there is no "one size fits all," unfortunately. I know this is a lot to absorb and it's not just a game-changer, it can be a life-changer. Takes time to get acclimated to what is happening to your body, and it's hard to know what to do next sometimes. I'm glad you've found us.

Knowledge is power, and there is just a ton of information captured in the 'sticky' threads at the top of this forum. If you're interested in a certain aspect, you can use the Forum Search function (located in the upper righthand portion of your screen) to punch in key words where prompted, to pull up threads and posts containing past discussions on here (regarding surgery, for example, or PT, nerve blocks, etc. The possibilities are infinite and thrilling!).

Please keep posting here to let us know how you're doing, OK? We're here to support you should you have any questions or concerns.

Take care and I hope you feel better soon.

Alison

Tos
 

Ok, well first thank you for your comfort and understanding. It means a lot. Ok, I saw Dr. Annest in Denver a few weeks ago. He did some tests and read my file, what a great guy he is. He diagnosed me with TOS. He told me that he wanted me to see Dr. sanders and get a pec minor block. So on Dec. 9 I am seeing Dr. Sanders and I am having a block and I am also seeing Dr. Annest after that appointment.
Yes, I have been thru a lot of therapy appointments for sure. My PT is great and she has been with me since the very first day just three days after the incident. Let's see, the injections were done under x ray and ultrasound. The second injection took the doc 25 minutes, he was quite ****** because he couldn't find my nerves. Afterwards he said that I had a lot of swelling and he thought there might be something wrong with my nerves like they might be pinched or covered or extremely small, not sure. Neither injection worked by the way. I recently had dry needling done and that was not good. It has been a very long road for me but I'm sure not as long as some of you all. My career is done and I'm not sure on what lies ahead. Fortunately worker comp here in Wyoming has been great to me. My biggest worry is not surgery but it has to do what lies ahead after surgery and so forth. I try to stay hopeful and optimistic but it's hard.

Fellow patient
 

I am currently working with Dr. Sanders and he is great (will meet Dr. Annest soon for my surgery). I wish you all the best of luck with finding the right combination of PT, meds, and Drs to make your life easier. Remember you are not alone.

Plus... Stay safe while traveling to and from Denver this winter.

Sorry to hear about your struggles, we have all been there.

From my personal experience I would not delay the surgery if testing is showing you have TOS. Also PT is not recommended for vascular or arterial TOS which I had bilaterally. Mine was congenital so I am not sure if an accident can cause that but for this type of TOS the surgery has very good outcomes if you have a good surgeon. Have they tested the blood flow in your arms? CT or MRA with arms up?