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Join Date: Jan 2009
Location: Paradise
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Member
Join Date: Jan 2009
Location: Paradise
Posts: 855
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Quote:
Originally Posted by KathrynL
I've had 2 neurologists and 1 rheumatologist diagnose RSD type 1 in my left arm. I have a history of RSD, eight years ago. Now my physical therapist told me he suspects a shoulder injury (probable torn rotator cuff) coupled with TOS, and maybe not RSD. Another possiblity is that I have a shoulder injury and that shoulder injury caused the RSD. I have psoriatic arthritis, so a shoulder injury is possible.
He wants to do a MRI of my left shoulder. Beyond the pain in my shoulder, he thinks the arm pain is more specific, and less diffuse than the pain seen in RSD. I have pain throughout my entire arm, but it hurts more on the forearm, and less on the outside of my arm. My pain is diffuse, but I explained what I felt at the current moment, and that can change from second to second. Right now, the top of my arm does hurt. He said he usually sees more pinkish discoloration. My discoloration tends to come and go and wasn't as bad as when I was in PT. My discoloration is also more blue and purple, than pink. And my forearm is more discolored (probably because it's paler so more visible) than my upper arm.
As people here know, the diagnostic process is so frustrating. I've finally made some progress, so for my PT to now tell me he thinks it may not be RSD, is frustrating. Anyone have advice? Are there any important distinctions between TOS and RSD? I have no numbness and tingling and my fingers are spared, though I have burning on the front part of my hand. I have constant pricking sensations like needles being poked into my skin or polyester being rubbed on a raw sunburn. I have hypersensitivity that worsens the burning sensations. Cold (especially cold water) increases the burning.
The EMG and nerve conduction tests were normal, but showed a mild abnormality in nerve conduction time that the doc attributed to the colder temperature in that arm. There was about a 5 degree celsius temperature difference between extremities.
I don't think I have TOS. I think I could have a shoulder injury and that caused the RSD, but I don't think I have TOS. I'm not a doctor though.
It's important to note, this was my first visit with the PT.
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This topic is very complicated. PT's have a better feel for what's going on since they see you 2 or 3 times per week over weeks or months; your doc might only see you 2 or 3 times. But then traditionally, PT's are not trained in diagnoses, differential diagnosis, lab or radiographic diagnosis. They are trained to "assess" a problem from the perspective of implementing a therapeutic protocol. But that doesn't mean they are wrong with their thoughts.
As far as TOS, there are numerous shared physical findings. I wouldn't want to make the mistake of going thru a first rib resection for TOS when it was really RSD where more surgery might send you to a new level of uncontrolled pain. There are several tests that help steer a diagnoses towards TOS; EMG, NCV, SEP, arteriogram with the arm abducted. TOS affects the neurovascular bundle so both systems can be affected. For RSD, you can get into triple phase bone scan, thermography as well but as you probably know, there isno specific test for RSD.
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06-27-2012, 09:02 AM
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