Hi guys,

Some intersting developments I wanted to post about if it could help anyone. My TOS has never acted like other peoples. Mine was more upper plexus as opposed to lower plexus. I never really had the numb pinke and ring finger, rather mine were thumb, first and middle finger although my pain was always more up in the shoulder and neck area. But all the usual tests for TOS came positive for me. The pulse test and the UCLA MRI showed compression. BUt I never really had a definite 1st rib problem. But I had my right anterior and middle scalene operated on and I improved decently. But pain always remained to some degree and then the left side/shoulder developed problems.

And now I think I know why. And maybe my issue produced TOS like issues but might not have been really true TOS. Or the TOS is secondary to the real issue.

As some of you may know I have had a left frozen shoulder for some time now. Started about 3 years ago after my surgery for TOS on the right side. At first threapy was going well and within 6 months I had some good range back. But then I tripped down 3 small steps and put my arms behind me to break my fall. Well that left shoulder went back to pretty much zero range of motion and it was really slow going the next 2 years to get it back. About a year ago I got a cortisone shot to the shoulder from an othro who has tuned out to be a complete jerk. The shot was way more painful than it should have been. Thought is he probably injected into a frozen/inflammed area that made it worse, that the cortison crystallizes which causes more inflammation, that the shot and this frozen shoulder caused RSd in the left shoulder.

Funny thing is the range got better and the frozen aspect got better from the shot. But the pain got worse. I got more range lifting up and am probably at 160 degree which is good. Internal rotation is decent but external rotation is still bad. And then I did some more shots and range improved but pain got worse. The more the range improves, the less diffuse the pain and the more acute and localized it is.

Fast forward to now, after seeing multiple docs, I have been told that its likely that I have an internal impingement or whats called a suprascaplar nerve impingement at the suprascapular notch. The MRI of the shoulder shows damage that is not rreally consistent with the pain that I have. I have some moderate tendonitis of the rotator cuff, subacromial bursitis, small labral tear and small tear in the supraspinatus tendon. Biceps and bicipital groove tendinosis. But all that stuff is considered minor to moderate but not enough to be considered a true rotator cuff issue.

The EMG pointed to a suprascapular nervre problem. And a smart physiatrist did an ultrasound that actually showed a swollen suprascapular nerve at the notch. Bingo a swollen nerve! But getting anyone to pay attention to that report was like um yeah thats a rare impingement we never see this. And yet poor extrenal rotation problem is a classic sign of suprascapular nerve impingement. And most of my problems were upper plexus and well the suprascapular nerve is considered upper plexus in origin. Its all fitting together.

What finally struck me was the neuro that wrote a letter to two of my docs and said "there is a distinct mechanical shoulder problem that is causing left shoulder girdle reactive muscle spasm leading to an impingement on the brachial plexus that is causing a phenomenon that is similar to thoracic outlet but not a true thoracic outlet syndrome." Well that explains why the pain is so similar to the right side from 5 years ago. And what also struck me was he said that the sholder impingement is causing the shoulder to roll forward and pull the first rib joint out of place putting pressure and creating TOS like pain. The nerve impingement is also causing the pec minor to tighten because of the rolled forward nature of the shoulder. TOS like pain yet the source is actually in the shoulder and near the thoracic outlet but not true TOS.

This specific nerve impingement is rarely diagnosed and most doctors (orthos and neuros) never see this or recognize it. One neuro told me that there has only been one study over time that has been done on this type of nerve impingement.

He heard a neurosurgeon talk about this impingement and how it is more common than thought and grossly underdiagnosed. Google it and you will read its really rare or just really underdiagnosed. I read one article that said it affects people that carry heavy loads on their shoulders. And all my problems did begin after carrying extremely heavy luggage on both shoulders for some consecutive trips. And the fall during the frozen shoulder jammed that poor little nerve into the notch where it is impinged even further.

The left shoulder has now developed RSD which we are treating. But in the end it will likley need surgery becasue until the nerve is freed it will continue this cycle of pain.

So I might not be one of all of you after all. Just maybe a psuedo TOS patient with TOS like pain caused by a shoulder nerve impingement that is considered rare but may just be overlooked.

I wrote this so others in case others have TOS like pain but dont quite fit the bill like I did. Or for those with frozen shoulder that does not really improve beyond a certain point.

So maybe in the end its my explanation for my pain. Wont know until actually surgery is done but the logic and the tests certainly point to this poor little nerve as the culprit.

Hope I can still hang with all of ya . Will keep ya posted as to how this develops.

So dont ever give up or stop questioning.

Shelley

This is good info to have posted.
It may be helpful for others that might not fit TOS symptoms exactly.

Sounds like a long and winding road with trying to figure it all out.

But if you eventually do have that surgery and it does fix many symptoms for you , that would be so cool.

more info on "suprascapular nerve impingement at the suprascapular notch"

http://www.google.com/search?hl=en&c...+notch&spell=1

Shelly, I have never had a cortisone shot that did not hurt way more than it was supposed to.

I am probably at 160 too, but with arms overhead my trunk has poor side bending. In yoga they showed me how to do the same side bend with hands in prayer position. The side bending range increases dramatically.

Hay, saddles, and book bags were a heavy load way of life for me back then.

The opinion I listened to in deciding not to have surgery was that I don't have TOS or I have it but a very mild form.

I hope you do and I hope I can too!

Hey Tied,

Was rading something that connected to your comment about side bending and that yoga prayer pose. Apparently when you have your arms in that prayer format try maintaining the prayer with hands together and lift up those arms. It works the lower trapezius muscle which is apparently very weak on TOS and shoulder injuries becasue the upper trap overworks. Google lower trapezius stretches. I light bulb went off for me when you mentioned prayer pose.