Hi everyone...I am new here and in searchof some help. I was just diagnosed with thoracic outlet syndrome and am still a bit confused over it all. It first started out to be carpal tunnel but the EMG showed otherwise. I have been to different Dr's and been through several tests and MRI's. I am in so much pain I just can't stand it anymore. I cry because I can't do anything! I can't comb my hair, my hand gets numb and ice cold..I hate it! I can't sit, stand, lay down...you name it..I can't do it. I have a clerical job with a lot of data entry (A LOT) with terrible working conditions. I know this caused it and yet I have bene trying to go to work and do my job while crying in pain. Nobody cares...other employees have even spread rumors that i'm faking it! I can't stand it. Well anyways, theneurologist feels I need some fast pain relief and wants to do a nerve injection TOMORROW and i'm freaking out! I'm scared...he didn't explain much about it and I don't know if this is the answer. He said if I didn't do this I would need months of therapy and stuff and still be suffering in pain. He never mentioned surgery but he said I may need therapy. Everywhere I look, therapy is involved.

Has anyone had injections of lanacane? Do they work? Do I go through with it tomorrow and then go from there. I need my life back but I don't know what's right and how to get this fixed. He said I'd be better in a few days after the injection...ok..then what..back to work and hurt some more?

I filed workman's comp today and my companu is giving me a hard time. I'm a mess and ready to just give up. I'm at the end of my rope with everyone. Can anyone offer some help? What do I do...and boy do I need some sleep.

T

First I would like to welcome you to our forum. I am sorry that you have been diagnosed with TOS.
If you could you be a little more specific on what type of injection that your Dr wants to give to you? I have had a scalene injections which consisted of marcaine and kenalog injected into the scalene muscle. The procedure provided temporary relief for me and was also used as a diagnostic procedure to confirm the need for surgery. There are also trigger point injections that are given to treat extremely painful areas of a muscle.
http://www.neurologychannel.com/tpi/, There are differant typs of Nerve blocks, this link helps explain a few http://www.clevelandclinic.org/healt...asp?index=4417 Some injections can provide relief for a period of time. Your Dr should have explained the procedure to you in detail.
What type of TOS have you been diagnosed with, is it bilateral, vascular TOS, neurogenic etc. Have you had a neurography, doppler ultra sounds or any other type of tests or just an EMG. I'm sorry so many questions..
If you go to therapy make sure that your physical therapist is trained in TOS as you should only be doing gentle range of motion exercise and nerve glides. NO Weights!!!
There is much information of this forum. In the upper left hand corner is a sticky with useful links. You can also search for in the right hand corner for information that other TOS'ers have posted.
Can I also suggest that you seek the consult of a lawyer for your Work Comp claim. TOS claims can be a bit difficult and it's good to have some help to get appropriate treatment down the road.
I hope that someone else from the forum will come along to offer you advice on injection and such. TOS pain can become very painful and appropriate treatment is necessary. Don't give up... Hang in there you need to get the right treatment for your TOS now.


Dawn

Just have a second to dash this off - FYI there is a Workers Compensation forum on this site which should give you scads of information. Good on you, mate for filing a claim, for you should be able to breathe much easier at work with those strong legal protections in place now. Your boss cannot fire you without some serious consequences to the company under the w/c laws. Those laws vary from state to state, so if the work environment continues to be hostile you may need the intervention and protection of a good workers comp attornery. I believe if you call your state's Bar Association you can get a referral. My understanding is that if an attorney takes your case most of them will work on spec and take their fees, expenses, etc. out of monies paid out at the settlement of your claim, but I don't know for sure how it works where you live. TOS can be tough to prove and a controversial diagnosis at best - just FYI. You might get some real peace of mind by consulting a w/c lawyer at this point, but taking no action with one at this early stage despite the bad behavior (keep it documented, though!) because (a) you don't want to tip your hand (b) they'll just go more on the defensive and make it even harder for you to be there.

The other immediate concern is the amount of acute pain and distress you are in, both physically and emotionally. Please know that if relief is not forthcoming you can ask your doctor to put you on temporary disability (I believe under most states' w/c laws this would essentially be a paid leave, but again I can't say for sure), so that you can receive the care you need to get out of the acute flare you are in. Your instincts are correct in that the workplace ergonomics and repetitive activities are no doubt reinjuring you daily. Get to HR asap if your company is large enough to have that in-house, or call the corporate office if no one else is stepping up to the plate: Your employer has a duty to provide the correct ergonomics and to give you the breaks you need (doctors' notes help here) once you put them on notice of your injury (which you have done by virtue of filing the claim).

Whew. OK it seems I am incapable of writing a short post. My apologies - just concerned about you. Sorry we had to meet like this! Good luck with the nerve block, I think it may help in the short run and buy you some time to find the right physical therapist, do some more reading here on TOS, get a gratis legal consult etc.

Hang in there. This is a lot to absorb. We are here to help.

Alison

Don't know a thing about workman's comp since I'm self employed but can say a bit about scalene blocks.

I had initial diagnostic ones that used a small amount of steroids (can't remember but believe it was methylprednisilone) and also a lidocaine type block (was something similar to lido but wasn't lido, don't think it was lanacane... really do need to get my med copies from Hopkins). For me, those 2 injections helped a bit but not for more than a few hours. To me they were more for diagnostic purposes than actual help. I had mine done at Hopkins where they used a CAT scan at the same time to properly guide the needle. They did hook me up to a saline IV but didn't numb the area any. Didn't need an numbing though as the doc that was doing the actual injections was extremely good (unfortunately he's rotated out to a different dept for his residency, boo hiss).

The botox injections I had 2 weeks later were a totally different story (same doc did that too). The scalene injection wasn't too bad at all (that one also just had a saline IV with no numbing at injection site). If I remember rightly, I think he did the initial placement needles using the CAT scan and then did the one injection. That one stung a bit due to volume amount but wasn't enough to make it memorable. Because I had only a small portion of the total vial injected into the scalene, there was quite a bit left so he offered to also do trigger points along my back and shoulders (of which I have many nasty little ones and big ones). I really liked the doc and admired his skill but he definitely took some glee in finding those trigger points and if I didn't know better, I'd almost say it was almost a sadistic glee. Brief as the injections were to the points, they weren't fun. I had I think 12 done or somewhere close to that. More on my right side than on my left (the right side is where I'm getting my upcoming surgery).

Immediate after effects were pretty much nil. I think I asked for some Tylenol afterwards and took and a 200 mg ibuprofen when I got in the car but I had no probs driving at all back home (3 hour drive). Most of the discomfort was from a headach from lack of food because I had to have empty stomach in case I had complications (just standard procedure on that).

The next morning was a bit hairy tho. Not sure if it was the botox injection or the combo of that and the trigger points but I woke up with a dead right arm for a bit. Course I was 3 hours away from Hopkins so had to go to my local hospital ER just to make sure I wasn't having a problem with circulation. The dead part didn't last long at all and I probably didn't need to go but Freischlag and I figured better safe than sorry. So I got to "enjoy" the ER for 5 hours. Fun, fun. Of course it'd pretty much cleared up by the time they got me back to a room but I still had to stick around another couple of hours to see the ER doc (who was actually quite nice and concerned to make sure everything was OK but by then the symptoms had disappeared).

Later that evening I started having a lot of discomfort (pain probably is a better word) in my sternocleido mastoideus and trapezius muscle areas. Not a clue what caused that as I didn't have any of that with the previous diagnostic injections. Freischlag said that botox can be irritating but I've had a number of injections through the frown lines to help my migraines and never had any issues there. She also said that the close time between the initial dx injections and the botox injections was probably also a big factor and that she would be changing her treatment protocols to make sure others had longer rest times between injections. In defense to Frieschlag, the short time was totally my doing. The CAT scan doc (not the injecting doc) was going away on vacation for over a month and I wanted to get the injections done before he left so I pulled a bunch of strings to get slipped in much quicker than would normally have happened. Can't say being the canary to that coal mine mishap was fun but at least I've helped others avoid my mistake.

Anyway, that pain lasted about a week before it faded completely. But I did start feeling better by about day 3 as to my TOS symptoms. And I had about a month and a half of no spasms, migraines, hand numbness, or pain of any kind and was able to go TOTALLY off painkillers, neurontin, and sleep meds. It was heaven! I was even able to touch my toes without any problems at all which I've not been able to do in a LONG time. I was not a happy camper when the botox started to fade.

Was going to go for more injections when it started wearing off but had to hassle with getting authorization from my insurance for the CAT scan part (everywhere in Hopkins BUT the radiology dept takes my ins. so had to jump thru hoops upon hoops) and then when I got the approval, the CAT scanner broke down and was out of commission for almost 2 months while they repaired it. By the time that got all fixed it just got to the point that I was having enough changes in symptoms that surgery was becoming obviously my best option to resolve my problems (much as I'm not really thrilled with the idea of it).

I know some in the forum have had bad or pretty much useless botox experiences but for mine, they were almost miraculous. My migraines have dramatically diminished in both numbers and severity. A couple of Midrin usually killed the headaches within a few hours and that wouldn't have even begun to do any good previous to the botox. After my C5-C6 fusion the migraines shifted drastically from being just 4 days of unrelenting pain to so bad that I was vomiting uncontrollably for hours on end even with IVs of meds being pumped into me to stop the pain and vomiting and the docs wanting to do spinal taps on me... those were not fun at all.

I got the botox last July and I'm just noticing within the past month or so that the migraines are starting to show up a bit more often and the hands are starting to go back to numb more at night (tho now it's more the whole arm rather than just the hands). I did find a wonderful pillow at Walmart (a squishy bead massage pillow shaped like those travel pillows you put around your neck) that I think has helped immensely on my night posture so I don't collapse the neck and shoulders as much. I'm fairly certain that that's probably helping stave off the worst of the returning symptoms. If I don't use the pillow, the TOS probs come back with a VENGANCE like they're trying to make up for lost time.

In my situation, if the botox injections had been an option to continue with over the long haul, I would have definitely gone that route. Freischlag says that they lose effectiveness with each injection and can be more irritating each time. Don't know if that's the case or not. Bit moot for me but for someone else, if done properly at a skilled facility, that might be a helpful treatment. I know it certainly helped me. I'll keep my fingers, eyes and toes crossed for you that your lanacane injection will be helpful for you and that you get some relief.

Mary