My first post. I have read a lot here, and there are lots of knowledgable folks. hope you can all help me too

I have seen several docs, got lucky to find a few who recognize adn treat TOS. However, before surgery I want to know which of all these tests, and where/who they are done have the best chance of helping my docs decide.

In no particular order:
Dr. Filler's nurogram
Dr. Collins MRI-MRA-MRV in LA
EMG and nerve conduction

I think x-ray is not helpful, I don't think I have cervical ribs
I also heard ultrasound of the arteries and veins can be good.

I heard Dr. Filler's test can be done several places around the country.
I also read that scalen anterior block is used before surgery.

I apologize because much of this has been covered before, but I keep waiting for something new and exciting!

So for one with no cervical ribs, TOS on both sides, after overuse on computer, how does one decide before surgery?

Thanks

Hello Walker, welcome to the forum.

Have you had some long term - TOS based PT {expert or advanced} , posture/bodywork, alternative therapies and /or expert chiropractic help?

What are you most bothersome symptoms?

Others will be along with info on those tests , I'm sure - I haven't had any of those.

moving my answer along with the original post:



Dr. Jordan does an ultrasound procedure during his scalene block and combines it with some type of EMG. He looks at Brachial plaexus, ulnar nerve and carpal tunnel for impingemnet and blood flow. He says he sees everything that can be seen in the MRI/MRA but the procedure is faster and much less expensive. Course less expensive to you doens't always mean less expensive overall since it also depends on what your insurance will cover as Jordan is out of network for all except medicare.

I really like Dr Jordan, had two sets of botox with him, but I am looking at surgery right now bc botox doesn't seem to be the answer for me.


Also, I am following up with a neurography (dr. fillers) bc I want to see the actual compression location before anyone cuts me open.

Johanna

Hi Walker,

Some tests are required in order to rule out other possible dx's, chest x-rays are usually done first off, not only to check for cervical ribs but to rule out abnormally long C-7 projections, and to check for tumors that could be compressing the brachial plexus, for instance. EMG/NCV's can be useful if nerve damage has already occurred that can be picked up by the equipment, an abnormal EMG often speeds up your access to Drs and treatment, including surgery. The one that is considered most indicative of TOS is called the C8 ulnar nerve root study across the brachial plexus. You may need to look for a neurologist at a university or large teaching hospital who has the training to do this.

Have you ruled out any vascular involvement? Doppler studies, done lying down and in positions that sx occur can be helpful.

At this time the tests are still lacking in precision - bone is easily seen but soft tissue just does not show up as well. The best TOS surgeons gather all the info they can from tests, but also depend on a very thorough clinical exam - amazingly thorough. Once they get in the OR and see the situation first-hand though, it is their experience of having done hundreds of these surgeries that allows them to quickly recognize what is causing the problems you are experiencing.

I can't stress enough the importance of choosing a Dr with a great deal of experience, who has a good reputation among former patients, and whom you personally trust and feel comfortable with. Don't settle for anything less because it's more convenient, or someone else thinks you should, or you've been through lots of surgeries before. You deserve the best surgeon working around your nerves!

beth

Thank you.

My limited reading says xray and cat scan shows bone, mri shows soft tissues. I am collecting a list of people who do mri's and catscans.

Is there a difference between looking at bone and soft tissue for surgeons?

special MRI's show special issues. special surgeons tend to like special MRI's.
MRI/MRA with contrast can show vascular compression
MR neurography (special MRI) can show nerve compression
Spiral CT (used in Denver) I think shows some good combination of bone/soft tissue.