After 18 months and 10+ doctor visits to neurosurgeons, neurologists, and orthopedists and many MRIs I finally found the right doctor and the right diagnostic exam. An MRA shows that I have a compression of my subclavian artery. I've had scapular pain, general shoulder pain, elbow pain (around the ulnar groove) and finger tingling in my pinky for sometime now.

Anyway, I'm wondering what specific exercises and stretches should be engaged in? I've done PT soooo many times I'm thinking of going it alone.

I must say, the second my ortho indicated TOS may be the culprit I started stretching my neck vigorously and consistently. For three weeks now I've stretched my neck every hour or so for 30-60 seconds. Amazingly, all the pain I mentioned above has diminished considerably. It's still lurking...I can tell.

I want to finish this off with a consistent attack of the right stretches and strengthening movements. From what I've read from the links, neck and pec minor stretching is recommended along with strengthening of the shoulder and back. That said, anyone have a very specific regimen that they would recommend with repetitions and frequency?

Thanks.

KY

Did the imaging show what is compressing the subclavian artery?
Or maybe causing it to be compressed in certain positions?
Knowing those details will give a better idea on what needs to be addressed.

Many of us have to explore & experiment to find what will work best for each of us. There isn't a specific amount of exercises or reps, just try what you can and see if it is feeling better or worse and adjust from there.
There is a good TOS program put out by Sharon Butler, that I have used and still do.
You can find the details on her website - www.selfcare4rsi.com
TOS pgm info- http://www.selfcare4rsi.com/thoracic...-syndrome.html
We just had some good bodywork style stretches posted lately -
http://neurotalk.psychcentral.com/thread149529.html


and these should be good for nearly anyone that has forward head /shoulders postures



foam roll or large towels rolled up tightly - pillow if needed for neck comfort - then just relax with arms at a comfortable position

Jo Mar,

Thanks for the reply.

I haven't met up with the doc yet to review results. He only indicated that I clearly have a compression of the subclavian artery.

This all started 18 months ago when I felt something "pull" in my trap/right shoulder area when doing a latpulldown movement. I wonder if this messed up my first rib in some way or the muscles attached to it? And despite doing every type of rehab under the sun the last 18 months, the one thing that I didn't do was stretch my neck!

From the pics you present, it would seem that scapular retraction and general stretching of the chest could be something to try. I already do quite a bit of scapular retraction using bands and also lying on my stomach on an exercise ball doing "superman's" with 5 - 8 lb dumbells.

I'll check out these other links. I'm really hoping that this newfound neck stretching was a missing link the past year and a half.

Thanks.

KY

did you go to the same PT/rehab therapists the whole time or did you move up to ones with more advanced training?

Most average PT places & rehab tend to implement a cookie cutter approach to therapy - same thing for all.
Doesn't really work for those w/TOS as we can have blood flow issues and /or nerve issues. Blood flow & nerves both affect how our muscles respond. We need to have skilled & individual PT plans with adjustments to the plan when needed.

A good one should be able to check your top rib/mobilize it if needed.

I don't know how much/often you are lifting / working out but overbuilding the neck muscles can be a factor with TOS. Crowds the areas- muscle begin to squeeze or press on the vascular system and/or nerves.

You may have some trigger points or sticky tissues causing some of your problems.
See Sharon Butler's website for more info on the sticky fascia & gentle stretching techniques - www.selfcare4rsi.com

Most of us don't do very well with resistance bands or free weights.
Generally after the symptoms & pain are reduced - then those things can be slowly introduced. But some are not able to get the pain reduced at all.
I caution you to be very careful with any strengthening for now , at least until your symptoms are greatly reduced.

What would you say your average pain level is per day?
none to 10 highest

Jo Mar,

I've been to several different PT/Therapists. I started out doing run of the mill rotator cuff therapy which of course was off the mark. When the burning scapular pain emerged, I started doing tissue work. In the end, I kept jumping around because nothing helped.

It was only after the pain ran down my arm to produce ulnar neuropathy issues that I ran into a manual orthopedic therapist. This was around December when my pain was at it's worst. I literally was bordering on RSD type behavior because I was so fearful of pain. This therapist worked the thoracic spine, neck/thoracic outlet, and pec minor areas over the course of a couple months. He also did some nerve gliding. This calmed down the situation quite a bit, but of course, I kept irritating the situation.

It wasn't until three weeks ago when I started to vigoriously stretch my neck that the symptoms started to seriously recede. This last manual therapist was on the right track, but the work was just too infrequent (and costly!).

My doc actually mentioned that my previous training could have resulted in hypertrophy of the neck muscles. Since my blow up in November of the ulnar symptoms, I've done didly on the resistance training front. For two months I hardly had function of my right arm.

I actually just purchased Sharon's book on TOS.

As for pain, it's gone down drastically since I started stretching my neck. On average, I'm at 1-2 now. Prior to stretching three weeks ago, I was probably 4 -6 and it was painful to bend my right arm. And in November/December I was off the charts...definitely a 10.

KY

kyounle, tell me more, after 2 years of searching and going to may dr.s mri's and the such, im thinking tos might be my problem also. very painful at times. neck shoulder, numbness in arms and fingers. do you have much chest pain and pressure, thinking you might be having a heart attack at times?
please tell me more... are you from ky. i'm from owensboro
info would be greatly appreciated

thanks

I definitely don't have neck or chest pain. In my case, it started with scapular pain, then the pain migrated south to the armpit, then in a big way at the elbow with ulnar compression, and finally the last two digits in the finger.

Will finally be getting my post MRA follow-up appt with the doc next week to see what he officially has to say. I'm eager to understand exactly what is causing the compression. Considering the progress I've made by simply stretching my scalenes, I wonder if his initial call of "transient TOS" could be it. His thought was that this was specific to hypertrophy of the scalenes due to my training. We'll see.

KY