Hi TOSers. I have been reading this section on and off for several years since I developed CRPSII in my left arm due to an ulnar nerve surgery. Anyway, I have been having trouble with my right arm and hand so I went to my pain management doctor and he ordered ultrasound test on both brachial plexis areas.

The report states: Right-sided thoracic outlet obstruction which appears to be dure to compression of the mid to distal right subclavian vein posterior to the clavicle. Severely elevated velocities up to 219 cm/sec are noted.
The left side is well within normal limits and there is no positional abnormality present.

Can anyone explain to me what this means and what should be my next step? The pain doc seemed to think I need to have a rib removed before I even have an MRI or anything. What is typically the next step and what type of doctor do you all see?

I am so scared, Elyse

hi

You've come to the right place for advice as there are so many people here with lots of experience.

I know that somewhere on the forum (maybe in the general info ?) there is a helpful diagram of the thoracic outlet which explains how close everything is in the thoracic outlet. The subclavian vein runs in the area and if it gets squashed when the space is narrowed, you can get significant symptoms. The severely elevated velocities bit is referring to how narrowed the vein is - and those numbers are high ie. the vein is quite narrow. The doctors might also get concerned that as the vein is narrow, you can be at increased risk of getting a clot in the vein as the blood supply is sluggish.

You say that you've been having trouble with your arm but it might help to know what symptoms you've been having. You may need surgery but most of us have tried specific physio first to try to open the space up. Your doctor definitely needs to refer you to a specialist vascular surgeon who can talk through all your options and they may want to do some imaging rather than just relying on ultrasound. I had to have a special kind of angiogram rather than MRI scan but UK and US are different in many ways!

hope this helps a bit - I had months of scary symptoms without a diagnosis and I remember how hard it was....I didn't find this forum till afterwards but wish I'd found it earlier.

Take care

Jenny

Hi, and welcome to NT

I'm from Eastern KY.

Don't know if Dr. Erdogan Atasoy, with Klinert Kutz, right there in Louisville is still practicing. If he is, run to him ! ! ! ! He's great. World Renowned too.

He helped me a lot. He offered me surgery but I refused for a thousand reasons. He still helped me in so many ways. I just can't say enough good things about him and his nurse Candi.

So much to tell. So many things to try.

You know your body best.

The "SEARCH" button above is very useful.

TOS is very difficult to deal with. We're here for you.

Here's our useful sticky thread - explore it for testing info, articles and many of our polls about surgery, symptoms, treatments and much more - there are also some diagrams & images that show the areas involved -
http://neurotalk.psychcentral.com/thread84-2.html

thank you for the help. I was very worried when I looked on the internet and I started to see things like - UEDVT (upper extremity deep vein thrombosis). I have an appointment to see my primary care doctor tomorrow morning first thing.

It is funny because my right side seemed to be more of carpel tunnel and ulnar nerve problems. I noticed over the past five months I can't put weight or pressure on my right wrist. I can feel my hand getting cold and tingly a lot in the past week (since I have been seeing a PT), and my hand is swollen. I am very nervous and full of anxiety (story of my life since all the medical problems with RSD on the left arm). I am so grateful for the help. I am so scared.

Elyse

'very nervous and full of anxiety '

These things will cause any of us to tense up and not breath fully- all bad for health , we need that oxygen and to breath out the bad air.
plus you hold the tension in the muscles too and that makes comfort even harder to achieve.

look for some videos on Google or you tube about relaxation and relaxing sounds- to help you destress.

If those are not very helpful -and since you have a chronic pain condition already -maybe ask dr about anti depressant or anxiety meds???
Some of those AD's work with pain meds to make them more effective.

i have not had an ultrasound

i think im going to try to schedule one, nobodys even mentioned it to me

It'll be OK...

You're not alone...

We understand and have been there...

Here is Dr. Atasoy's info...

http://www.kleinertkutz.com/physicians/atasoy

I highly recommend him. Very knowledgeable... and caring

It takes a while to get in for an appointment. and even longer to get in to see him at your appointment date and time. he's so worth the wait, though.

don't misunderstand. no quick fix. just understanding and direction and options to consider. PRICELESS ! ! ! !

He helped me sooooo much.

I would love to see him again, and may because of the fleece warm need for my upper arms, scapulas and scalenes, and now hot flashes. I'll bet he hasn't had that one before. I still don't want any surgery but he may have a better fix. Black cohosh is helping but still not acceptable. double trouble at night.

Life keeps coming at you