I have herniated disc in C5, C6 and always have tingling in my neck area especially when walking. Injections help a bit, but not for long.

Hey Joe,

For what it's worth, I have neurogenic thoracic outlet syndrome, and I've had the exact same symptoms for quite some time (about 4-5 years). I'm 6 months post-op (bilateral first rib resection, bilateral anterior scalene resection, bilateral pectoralis minor resection), and I've had these symptoms both before and after surgery. It did get better right after surgery, but as scar tissue built up and I started using my arms again, the numbness and tingling in my upper back returned. In general, it's across my entire upper back, but is the worst between my shoulder blade and spine on both sides.

Many doctors/therapists will tell you it's muscle spasms, or unrelated to your other symptoms, or a myriad of other explanations. They are wrong. Many of these individuals, while they may be very intelligent or successful, do not have a good understanding of thoracic outlet syndrome, including what causes it, how it manifests itself, how to diagnose it, and how to treat it. The symptoms you're seeing are directly related to the nerve compression at or about the brachial plexus. Compression of the nerves and nerve roots can cause symptoms of pain and parasthesia (numbness and tingling) both locally and at other points on the body which those nerves [are supposed to] innervate.

If it's TOS, an MRI is pretty much worthless in this situation, unless you're looking for lesions on the nerves. A good place to start would be to get an EMG, and by someone who knows how to test using the medial antebrachial cutaneous (MAC) nerve, the most recent protocol for testing for TOS using an EMG. However, don't be disappointed if the EMG comes back normal - most doctors don't know how to correctly perform or interpret an EMG when specifically looking for TOS, and even if they do, TOS doesn't always show up conclusively in the EMG test results. I dunno where you live, but I would talk to a leading expert in the field, such as the guys over in Denver (Dr. Richard Sanders or Dr. Steve Annest). Good TOS-knowledgeable doctors are hard to find, simply because there aren't many, but those two are an example of the ones that do. *edit*

In terms of physically trying to find some relief from TOS, you have a few options, most notably:

1. Physical therapy to stretch out the muscles surrounding the plexus and the paths of the nerves that stem from it. This includes the teres major, teres minor, pectoralis minor, latissimus dorsi, and others in that general area. Doing so will give the nerves more room to move freely. There are some strengthening exercises you can also do for the trapezius/rhomboid muscles so that your body naturally holds itself in good posture (shoulders back, chest out, etc.), but you have to be extremely careful when it comes to strengthening - if you don't know exactly what a particular exercise involves (physiologically) and why it benefits someone with TOS, there is a very, very good chance you will do more harm than good. There are a lot of doctors and therapists out there advocating resistance bands and/or weight-training that requires use of the teres major/teres minor/pectoralis minor/etc., which is a terrible idea and one I can almost guarantee will do more harm than good.
2. Have the area surgically decompressed. This should be your last ditch effort unless you're at risk of losing life or limb, such as those with vascular/arterial TOS (which can cause blood clots, strokes, and/or pulmonary embolisms). Speaking from personal experience, it's a long, difficult, expensive, painful, and mentally trying recovery from neurogenic TOS surgery that usually requires a minimum of 3 months on short-term disability, and the success rates are not very good for non-vascular TOS: around 50% have a "successful" outcome (some benefit, even if only a little), and only a fraction of those have considerable improvement, despite what your surgeon may tell you. I really mean it when I say you should exhaust all possibilities before considering this.
3. Stop weight-lifting so that the muscles shrink and give the plexus area more space. Probably not what you want to hear as a weight-lifter, but it's up to you to gauge whether or not it's more important to you to be muscular or symptom-free. Sure, it's a crappy ultimatum, but I had to make the same call; I grudgingly gave up a lifelong obsession with music and guitars when it became too painful and costly (in terms of my health) to make music. I need to put food on the table and a roof over my head, and I can barely make it through the work day as it is.
4. Try your luck with prescription medicine. There are a bunch of meds that can help with this, ranging from painkillers (narcotics are unfortunately the only things that touch nerve pain) to those that target the nerves themselves (such as Lyrica, Neurontin, and Lidoderm patches). What works for any one individual is mostly a trial-and-error process.
5. Nerve blocks If you can find a TOS-knowledgeable physician, or at least someone familiar with thoracic surgery/physiology, you can try to get a nerve block for the ulnar, median, and/or radial nerves. Doing so can help you get some relief from the incessant pain and parasthesia.

Whatever you decide, make sure you do something before it gets too bad. If I had known several years ago what I know now about TOS, I could have given myself a much better chance at a favorable outcome. As cliche as it may sound, education is most certainly a big key to success here. I know more about TOS than I ever wanted to, but it's helping me mentally cope and physically participate in life (to some degree, anyways...) while dealing with this debilitating condition each day. It equips me with the knowledge to be my own healthcare advocate, and to allows me to better help my doctors so that they in turn can help me better. TOS sucks, but it doesn't have to rule every aspect of your life. Good luck!