Thoracic Outlet Syndrome Thoracic Outlet Syndrome/Brachial Plexopathy. In Memory Of DeAnne Marie.


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Old 03-21-2010, 12:07 AM #1
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Default article on trigger points and tos

I found a useful 2006 article from The Journal of Manual & Manipulative Therapy titled "Myofascial Trigger Points and Myofascial Pain Syndrome: A Critical Review of Recent Literature." It's a 48-page pdf.

I am unable to include the url, but it's from the Jan Dommerholt page at the Bethesda Physiocare website. UPDATE: I just realized the page is hard to navigate to; try googling bio_dommerholt-addl

It consists of summaries of recent articles along with comments (about 1/2 to 1 page for each article). On pp. E143-E145 it covers a 2005 article titled "Post-traumatic thoracic outlet syndrome (TOS)," by FM Crotti, presenting the results of thoracic outlet surgery for 280 patients. I think readers might be interested in reading the comments:

"Although this paper mentions MTrPs only briefly, the findings have far-reaching consequences for clinical practice and the management of thoracic outlet syndrome. Basically, the authors, who are associated with a neurosurgery clinic, recognized two kinds of pain mechanisms evident in thoracic outlet syndrome. The neurogenic-vascular pain loop is treated successfully with surgery. However, the myofascial pain loop continues after surgery and may be responsible for the poor outcomes frequently reported for thoracic outlet syndrome surgery. Myofascial pain is not necessarily altered by surgery. Ninety percent of patients continued to suffer from myofascial pain following surgery, which prompted the authors to recommend that patients must be informed that the same pain symptoms from before surgery may indeed persist after surgery. Myofascial pain may in fact be the primary problem leading eventually to signs and symptoms of thoracic outlet syndrome3,41. Prior to surgery all patients were seen for at least 3 months in physical therapy. Brachial plexus entrapments are common with MTrPs in the pectoralis minor, and in the anterior and medial scalenes. It is not clear from this paper, to what extend physical therapy included any specific MTrP work, such as manual trigger point release, dry needling, injection therapy, or even postural corrections. The authors observed significant postural deviations, such as a lateral head tilt, an ipsi-lateral pelvic tilt, and scoliosis. These can all be associated with MTrPs in the scalene muscles, paraspinal muscles, and quadratus lumborum for example. The paper does not include the number of patients who did not require surgery after successful physical therapy intervention, leaving the question whether physical therapy and MTrP work can indeed prevent thoracic outlet surgery in a number of patients."

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Old 03-22-2010, 12:28 PM #2
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Found it -
http://www.bethesdaphysiocare.com/pr...nts14-2_06.pdf


I wish those PDF's used the whole page for a full sentence instead of the 2 sections and having to scroll down and then back up to read each page !

{my vent LOL}
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Old 03-23-2010, 03:00 PM #3
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Thanks. I think the main takeaways are 1) trigger points can be a cause of TOS, and 2) trigger points can cause some of the symptoms that are often associated with TOS, but which may not be caused by the TOS itself.

Now that I can add urls, I might as well give the google books link for the Trigger Point Manual, v. 1:
http://books.google.com/books?id=sU0...ndrome&f=false

The section on TOS begins at the end of p. 518, which I can't see online, since it's a limited preview, but if you start reading from 519 you'll only miss the following 1 1/2 sentences at the beginning: "The thoracic outlet syndrome is a collection of symptoms. Like low back pain, it..." (Some later pages are missing, too, I see; still worth looking at).

Disclaimer: when I saw a neurologist a few years ago after 10+ years of suffering, her response was that I did display some physical signs of TOS, but, based on my pain complaints, she was willing only to say that I may have been "leaning toward TOS" but not that I had "full-fledged TOS." Now, I had over the years learned to largely control my once-extreme pain, and my problems at the time were largely tiredness, dizziness, and hand coordination problems (all of which are better now), so I don't know (maybe I should make a bio page, so I don't need to keep repeating this).

What I will say is 1) a lot of my symptoms were definitely the result of scalene tightness caused by chest breathing, and, 2) over the last year, since I first learned about trigger points, I've discovered one particularly obvious one in the left side of my upper back, and two in the left side of the crease between my legs and my belly, and I'm confident these are causes of my chest breathing, as well as the causes of some of my other symptoms.

Also, I have never had a doctor or pt mention trigger points to me - and this includes some supposedly top pain specialists - or display more than a very superficial knowledge of the subject when I raised it. It's a problem.

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Old 03-23-2010, 06:14 PM #4
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I found the same thing...
Drs don't mention it {TrPs}
PTs don't either but if you ask or bring it up they usually will share what they know & find if it pertains to you.
{some are better than others- I guess that fits for all LOL}

I came across the info on trigger points reading & looking for any kind of self help on RSI & TOS.

i have quite a few trigger point info links in the useful stickys also- post #1.
http://neurotalk.psychcentral.com/thread84.html

this was one of my favorites-
http://www.pressurepointer.com/pain_reference_chart.htm
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Old 03-24-2010, 12:08 AM #5
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Actually, I just realized that the link you provided is not the one I was thinking of. This is it:
http://www.bethesdaphysiocare.com/pr...lreview_06.pdf

The TOS study starts at the bottom of p. 20 of the pdf (p. E143 of the publication).

I like this because it discusses the strengths and weaknesses of all the studies covered.

Here is Jan Dommerholt's page, which links to many of his publications (mostly about trigger points), including the one you posted above.
http://www.bethesdaphysiocare.com/ab...holt-addl.html

I have more links on the subject that I've found helpful, if you're interested.

I'm thinking about giving trigger point acupuncture a whirl, now that I'm relatively confident about where my major ones are located.

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