[mspennyloafer]

so i have some form of thoracic outlet syndrome even though i cant get an offical dx bc all my tests are normal, cervical mri, emg, ncv, etc


my shoulders are winged and ive been doing strengthening exercises for my serratus anterior. my hands have all been numb "slightly gloved" for two years now 24/7.

within the last two weeks ive noticed my middle finger is becoming considerably more numb than my other fingers. my physical therapist said my c7 transverse process was 'slightly big' i mentioned this to my doctor and she didnt take it seriously

so if you guys were me, what would you do

get a brachial plexus mri
ct scan
sitting cervical mri?

i am not a good candidate for any surgery bc i have ehlers danlos syndrome but id consider it if one of my tests showed an overt issue

[pebblebeach2]

Hi. Really not sure what to recommend. For one thing though I was always taught that an MRI is better then a CT scan. Gives better details when trying to determine what is wrong. Right or wrong I don't know but that is always what I was taught.

You asked whether you should have a Cervical MRI, Ct scan or brachial Plexus MRI. Didn't you state that you already had a cervical MRI plus other tests like EMG NCV tests that were normal?

I am not familiar with a brachial plexus MRI so cant comment on it. I guess that would be the next logical test if you've had the other tests done and they were normal.

What did cross my mine and you didn't state it in your post but what type of doctor are seeing for a diagnosis? Getting to the right specialist is extremely important. And at least in my opinion if you are near a major teaching hospital I would suggest going that route.

Hope you get the answers that you are looking for ...

[Leesa]

You said you had a cervical MRI, but what about a thoracic MRI -- you'd want it done with and without contrast material -- you'll get better results this way. I agree that an MRI is better than a CT scan as the results are clearer.

If you're not seeing a Neurosurgeon, you might want to get a referral to one, or perhaps an orthopedic surgeon. I prefer Neurosurgeons myself. You could go JUST for an opinion - not necessarily for a surgery consult.

I wish you the best --- I hope you can get some answers. God bless! Hugs, Lee

[Dr. Smith]

Originally Posted by pebblebeach2

Hi. Really not sure what to recommend. For one thing though I was always taught that an MRI is better then a CT scan. Gives better details when trying to determine what is wrong. Right or wrong I don't know but that is always what I was taught.

They each have their advantages and disadvantages. CT scans are better for bone & calcifications, while MRIs are better for soft tissue imaging.
http://en.wikipedia.org/wiki/MRI#MRI_versus_CT

Insurance companies are clamping down on MRIs nowadays. A few years back, some doctors were ordering them at almost every whim (because they are a good diagnostic tool and saved time) but they are also very expensive compared to other forms of imaging.

Now doctors have to jump through ins. co. hoops, trying less expensive tests first, and only ordering MRIs if still/truly warranted.

The downside to CT scans (IMO) is the radiation exposure, which can be 30 -50+ times that of a chest x-ray.
http://en.wikipedia.org/wiki/Ct_scan#Typical_scan_dose

Since the exposure is cumulative, one or several over the course of a lifetime is probably of little concern, but many, especially within a short period, can have adverse effects and raise the risk of some cancers. This is another reason some doctors and patients prefer MRIs, which do not involve radiation.
http://en.wikipedia.org/wiki/Ct_scan#Adverse_effects

Doc

[Dubious]

Originally Posted by mspennyloafer

so i have some form of thoracic outlet syndrome even though i cant get an offical dx bc all my tests are normal, cervical mri, emg, ncv, etc


my shoulders are winged and ive been doing strengthening exercises for my serratus anterior. my hands have all been numb "slightly gloved" for two years now 24/7.

within the last two weeks ive noticed my middle finger is becoming considerably more numb than my other fingers. my physical therapist said my c7 transverse process was 'slightly big' i mentioned this to my doctor and she didnt take it seriously

so if you guys were me, what would you do

get a brachial plexus mri
ct scan
sitting cervical mri?

i am not a good candidate for any surgery bc i have ehlers danlos syndrome but id consider it if one of my tests showed an overt issue

Well, asking anyone here such a technical question about your health and potential surgical concerns is like asking a 1st grader to solve our nation's financial crisis.

But since you asked, your slightly large cervical TP is interesting in that if it were large enough it may have significance for your symptoms. I would ask about an MR neurogram. A CT would be useless as it is better suited for bony issues vs. MRI. Sitting MRI is still evolutionary and there is not enough normative data to really describe what is normal and what is not. Besides, the magnet is usually low Tesla (0.6T or so vs. 1.5 to 3.0T for conventioanl MRI) image quality is decreased and scan times are twice as long.

Another condsideration that you didn't mention is an arteriogram of the subclavian artery neutral and with abduction. Also, in concert with that would be a full neurodiagnostic work up; NCV, EMG and SSEP. Imaging is anatomic; neurodiagnostic or arteriography is physiologic. Physician wise, a thoracic surgeon trumps a neurosurgeon or orthopedist for your issues.