Ann,

I haven't seen Dr. Avery yet for a follow-up, my Primary, by chance, is pretty well-versed in TOS. I had PremiereScan fax the report directly to me and I'm interpreting it as best I can on my own before I go talk to the Docs.

This is a VERY detailed mapping of the brachial plexus, specific to diagnosing the "Real" cause for TOS symptoms. Its a good 3 full pages, with 10 listed impressions.
My wife is an RN, so she's able to help with all the anatomical terms. Still, I bought a "Color Atlas of Human Anatomy" for $20 at Barnes & Noble.

To answer your question, on the right it narrows to a minimum of 11mm and on the left to a minimum of 14. I have no idea what normal is?

Dr. W's impressions include numerous anomolies in both scalene triangles, many appear to be genetic and others have occurred over time.

He says no incidence of Cervical ribs, just mild to moderately enlargements of both C7 transverse processes. I'm now convinced different DRs have different definitions of cervical ribs, because I've had them pointed out to me on an x-ray more than once and had one vascular surgeon ready to cut 'em out after a 20 second review of my x-ray.

Most disturbing is an anomalous aortic arch, with several anomolies including a left dorsal scapular artery piercing the middle scalene muscle. Haven't studied enough to know what that means, it looks normal on the anatomy charts. An additional right transverse cervical artery coursing anterior to the anterior scalene. More stuff too...

Moderate right and mild left extrinsic compression of subclavian veins on hyperabduction.

I think I'm going to send it to Dr. Sanders in Denver,...hoping to evaluate for the "pectoralis minor tenotomy" as a stopgap measure before getting scalenectomies, etc. If I can hold out for another year or so my disability insurance gets much better.

As always, just taking it day-by-day at the moment and trying to stay upbeat and not let the pain, etc. get to me. The chest pain worries me more than anything, its a recent development, comes along with flares, and scares me to no end. I've had full heart workups recently, and EKGs while it was happening and I could barely speak, and everything looked normal.

But us TOSers know about Drs telling us everthing looks normal

Marabunta
No. California.

keep the information and sharing coming...
I hear Avery has lessened his practice.
Is it true?

Avery, Saunders, Brantigan, Annest, Filler....
Can we get them all in a room to agreee to disagreee with the best treatment.

Then we really can't since everyone's condition is different and they all have a different take on the surgery procedures

This is awesome! Thank you for sharing this with us. There is hope out there yet for people to be able to get the answers they need.

Peggy

marabunta,

Dr. Avery said that normal was 15-20mm, when he gave my report back he said mine were 6mm on the right and 7mm on left.....that explains why he wanted to do surgery asap....you might get lucky and be sent to Peter Edglowfor therapy, if you follow his program you will feel better, I've been in his program for about 6 months, but because of of small my narrowing is the therapy will never resolve my problem.....I have spoken to Dr. Sanders and he's thinks I shoud try the Pec procedure first ( of course, that's what he's selling ). And of course that's what I'll do before the other surgery. Good luck...I too am happy to have found Dr. Avery, he's very detailed and I do love details......

Ann

I think this is more true than any of us readily realize. TOS by definition is not an accepted disorder or disease, it is a "SYNDROME" and that is defined as a collection of symptoms and/or signs. There is ALWAYS an underlying disorder/disease. Since the brachial plexus area is so complex, there are many,many possible underlying disorders, many very difficult to readily identify. Many of us have more than one underlying disorder, some have exclusively different disorders, but we still match the collection of symptoms/signs called Thoracic Outlet Syndrome.

Medical imaging capability is growing exponentially, and I think "exploratory" surgery will become a relic of the past in the near future. Hopefully we'll rarely hear "We won't know until we get in there."

I am not in the industry, but I would highly advise anyone contemplating major surgery in an area as complex as the brachial plexus, get the best scans that you can, even if it means travelling for the scan. It will provide your surgeon with essential information. If there are any anomalies of nerve or vascular locations, your surgeon will know where to look to visualize these and avoid complications.

marabunta,

Just to give you a heads up....That amazing test we both had done that gave sooo much info is the same test that Dr. Sanders will tell you he doesn't put much merit into...In my last conversation with him, I brought up the test and what did he think.....and he said he felt they were too complicated and too difficult to read...Just thought you might want to know before you asked him to read it....Also I heard through this site that Dr. Avery is going to be doing the Pec procedure soon......Yippee for us. no traveling

Ann

That's interesting because I found it to be detailed yet concise. That's the reason, on Dr Avery's advice, I waited for Dr. W to be available instead of traveling elsewhere. I had heard that some of these specialized imaging reports can go on forever to the point of being ignored because it takes too long to read and comprehend them...but I really would have a hard time believing that's the case with this report.

TOS is such a complex animal, with symptoms for many coming from secondary disorders and not the original previously undiagnosed or symptomatic disorder.

For someone as experienced as Dr. Sanders, I wouldn't think the reports would be entirely necessary, and they've worked for so long without them. But in the case of multiple anatomical anomolies, which seem to be not so anomolous in TOSers, I think it pays to know what to expect and what they'll find before they go in there.

Did I miss the specific tests you mention?
Which tests did you have?

O, Wait
You mean the NEO Vista 3D Imaging?
So, it's like Dr. Collins' here down at UCLA

I am the developer of this test, and would like to add a few points for informational purposes.

The examination has several technical differences from Dr. Collins' excellent test in LA.

The interpretation of the test is focused more on the anatomy that is described in decades of surgical literature. I have been told by a very well-respected prestigious university that my report on each patient is "like I read the surgical report". In other words, the focus of my examination addresses the presence or absence of all the anomalies the surgeons would look for BEFORE they go in and do any procedure. The purposes are:

1. To prevent surgery on those patients with a syndrome like TOS but without correctable anatomic or pathologic problems. Some studies in the medical literature have demonstrated that up to 30% of TOS patients do not have anatomic anomalies of the scalene muscles. Why do surgery on these patients?
2. To prepare the surgeon for what he or she might expect before they go in. There are numerous vascular anomalies as well, with arteries in a very superficial location that the surgeon would want to avoid.
3. To provide objective evidence of pathology in TOS patients struggling to convince their physicians or insurers to take the symptoms of TOS seriously
4. To enable the medical community to correlate the known anatomic anomalies in any single patient with the patient's symptoms. This will hopefully allow docs in the future to better understand why some clinical signs and symptoms occur in some patients and not in others, which patients do better with surgery and which do better with PT, and to allow minimal or less invasive surgery in those patients with certain minor anomalies, rather than a rib resection or more major procedure.

While some of these may not be at their full potential right now, the design of the examination is based on hundreds of papers in the literature, and on the experience I have with hundreds of patients to date. I am optimistic that i can continue to contribute to understanding of this condition.

I visited with Dr. Sanders, a very nice man, and observed surgery, clinical examination of patients, and a pec minor block. I got to spend about fifteen minutes demonstrating some of this new MRI to Dr. Sanders, and he asked me to teach him how to read the examination. I think it is admirable for any physician to want to learn new things, but radiologists spend five years learning in residency and more years in fellowship, which makes it nearly impossible for a non-radiologist to learn ANY MRI, much less a new technique with up to a thousand images, in fifteen minutes. I CAN tell you that there are several physicians in the SF Bay area that use my examination on a regular basis, and I consult with them regularly to try to help them learn little bits over months to years. So Dr. Sanders is likely unable to read this new test, but that does not in any way mean it is too complex. It HAS to be complex because TOS is by nature so complex. I think Dr. Sanders is just setting his personal bar rather high, high enough that I wouldn't expect anyone, even as knowledgable as Dr. Sanders, to be able to meet it. Bear in mind that there are numerous papers in peer-reviewed radiology journals that are widely-accepted by expert radiologists. I think that expert opinion carries a lot of credibility.

Since we all know how complex TOS is, we should all expect that the MRI would be complex, as well. I have worked very hard over several years to be comprehensive, yet concise and and organized in my reports.

The website explaining more about this test will be up within a week. I welcome any questions people might have about the examination, although I cannot answer specific medical questions.

Have a great Sunday!