I am new to this area so just letting you know where I am with stuff. I asked ?? before about head pain and TOS. Mark said I should consult with one of the docs here so I have an appt with Dr. Annest on March 22. I have already had an EMG from my neuro and he told me I have TOS. Left side, that's all I know . I am a chef so repeditive motion is an issue. Mostly I have problems with my left hand and fingers. I had a lot of trigger injections so don't know if it 's arthritis or TOS. My main issue as I told before was my Trigeminal neuralgia. I have been told to have the MVD surgery but have been waining because of the severitiy of it and I just want to be sure it's not something else as I do have a variety of problems. A 2 hour doc visit seems quite long. can I get any iseas of what to expect. A friend at work has seen him before and has had the surgery and reccomends him highly. I have had PT and just do the home streches at home. I have had a neck x-ray and it was normal. I do notice when I turn my head it does trigger head pain though. I am so confused I just hope this doc can clarify everything for me. My ENT who is very knowledgeable does not think the TOS could effect the head where I show him. I also suffer from the monthly migraine which triggers my TN to days of hell. Is TOS also effected like the trigeminal nerve from the monthly visitor? My neck just feels very tight right now. I guess I have a lot of ?? so I should write them all down for the doc before I visit. Sorry for the rambling I've just had this head pain for two days now and am at my wits end. Jen

Hi Jen,
You are correct in going to the top doctors to get a perspective on you situation. So glad you are in that area to receive excellant treatment. My daughters first doctor appointment with a spciealist was almost 4 hours and mine was 2 1/2.

The doctors need a detailed history, not just today how you feel or symptoms, but a detailed hsitory all the way back to first symptoms, or what may have been an injury or repetative job that started all this.,
There are different types of TOS brachial compressions, some are neurogenic, some are vascular compression and others a small amount can be arterial with blood clots.

By then doing a complete examine, reproducing your symptoms, by hands on testing, the diagx is more readily confirmed. Thre are many test done to rul out other mimicing syndroms, and only a specially trained doctor can tell where the seperation of them are. For example cervical bulges or ehrniations. I have left side herniations but TOS primarly on the right (it has gone bilaterial).

SOmetimes an EMG/NVC test can show some entrapment or injury to the nrve but not until it is further advanced. The EMG test larger nerves that are motor nerve, they make the muscles move. But, TOS first affects the smaller sensory nerves, for example the ones that "Feel" heat of a candel, then the larger nerves "move" your hand away from it.

MRI can show bulges, but as we age everyone has bulges, that does not mean they have tos. Some people do ahve anomolies that make them have a TOS tendancy. Such as ; cervical ribs, larger collar bone structure, a scalense structure that has the vascular bundle passing through it at a level that is compressing.

So doctors will ahve you perform certain menovours to reproduce the symptoms; Addisons test, Roo's test, East test amoung several others. Also things like closing your eyes and relating to softness and pick sensations on the chest wall, shoulders, arm and hands and finger tips. One test I recall was something that had one point, two points and my daughter could nottell the difference at all. Also if the softness tip was rubbed against her collar bone area she had sensations of signals travel to the finger tips on one side and up the neck to face on the other.

After all this testing and collectiong of information the doctor will review his findings in details, perhaps order other special MRI, pr sonagrams, or testing for loss of pulse to have a better idea of what the extent is.

This takes at least two hours, I at times had an appointment with my daughters specialist that it took longer, and our appointment ran late, we realized that someone ahead of us is receiving the same detailed care we once had.

Ihate when I took her to a spine doctor once waited two hours and then ahd a 5 minute appointment that offered absolutly nothing! What a waist, not even a PT, an anti muscle spasm med, or review of any MRI's except to say not operable, not bad enough, live with it.

Wear an athletic type bra, or swim top to the appointment, unless otheres that saw Annest can advise what is better. Many have just a hospital gown on. Take all the results from prior testing and xrays, etc, the written report. Check if the doctor wants the reg. MRI to look at. Generally he will order his own, maybe he will want that ahead of time..call and check into that.

I wish you luck, you re in excellant hands.
Dianne

Thank you somuch for your detailed answer, I am grateful for all the info you gave. Jen