Wow. I keep coming up with the serratus anterior muscle when i search to find out why my pain is so severe in my ribs. Also when searching for stretches for that area.
It's the outside of the ribs, from the armpit down. Not in the middle chest like Costochondritis. I find it impossible to wear bras, etc. It doesn't hurt to breathe, just when touched or if I lie on my side.
Most of my TOS pain is posterior shoulder pain, bilaterally. Thats how this whole mess began. Then went to spasms in my neck and traps, then arm turned numb. Ulnar nerve is numb in the whole arm.
I've never had much pain in the front of my neck or upper chest area. Mainly pain in upper back ,ribs, arms and hands. Mine is vascular, and neuro TOS.
Very interesting reading towelhorse. ihtos

Dear Towelhorse,

I haveto say when I read your response and your symptoms, I got teary-eyed because that's exactly my symptoms.
************************************************** *****
1) worsening of the symptoms when elevating the arm
2) I'm a secretary --------- Some of the occupations that we see causing TOS include, working on assembly lines, keyboards, or 10-key pads, as well as filing or stocking shelves overhead
3) pain in the neck, shoulder, and arm; headaches in the back of the head; weakness of the arm and dropping things from the hand
4) The symptoms are often worse at night or when using the arm for work or other activities

1) the headache
2) the changed sensations in their hands and arms
3) the heavy arm feeling
4) why sleeping is so difficult most times
5) why they feel so tired most of the time
6) why their neck aches
7) why there are knots in the muscles in their upper back
8) why sitting with your arms out in front of your body for extended periods causes your condition to deteorate eg sitting at the computer
9) why bending down to the ground to pick things up is awkward.
10) why one day they might feel better or worse than another day
11) does anyone find that if they are sitting on a dining chair that they tend to lean back and move their feet foward rather than sitting upright.
************************************************** ***
I've never found someone who could pinpoint exactly what my symptoms are. I've also been told that I probably have RSD... I had rib resection surgery 2.5 years ago, am not better and probably developed RSD because of the surgery... I am so glad that you found a physical therapist who is able to help you.

Thank you so much for your contribution to this board. Everyone's experience and symptoms are different. But, it's nice for me to have someone else who can pinpoint and understand what some of us may be going through.

Is this her? Christine B Novak, PT, MS,

Author: Christine B Novak, PT, MS, Clinical Coordinator, Division of Plastic and Reconstructive Surgery, Research Associate Professor, Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine

Coauthor(s): Susan E Mackinnon, MD, FRCSC, FACS, Program Director, Division of Plastic and Reconstructive Surgery, Shoenberg Professor and Chief, Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine; Mark E Baratz, MD, Professor of Orthopedic Surgery, Medical College of Pennsylvania, Hahnemann School of Medicine; Vice Chair, Director and Program Director, Department of Orthopedic Surgery, Allegheny General Hospital

Christine B Novak, PT, MS, is a member of the following medical societies: American Association for Hand Surgery
more-
http://www.emedicine.com/orthoped/topic537.htm


page 6 might be interesting ?? actually beyond that is interesting too - I clicked for the HTML version but you can use PDF too
by way of MD names & topics that attended the -
AAHS 36th Annual Meeting
January 11-14, 2006
Loews Ventana Canyon Resort, Tucson, AZ

Program at a Glance
page 6 - http://72.14.253.104/search?q=cache:...ient=firefox-a

hello everyone,
i just spent 30 mins writing something which was a satirical comment on the medical system and how it is not meeting our needs but on reflection i have chosen not to post it because there are people who are looking for help not a smart alec critique of the systems inability to comprehend our condition.

i have made tremendous improvements over the last 6 months

i have thought for sometime about the things that make my condition worse they are
1) using my affected arm--it would be so bad that i would have to put it in a sling, i found that if i had a commitment that was in the evening, if i put my arm in the sling during the day prior to going out my condition (all aspects) was more tolerable.
2) sleeping--i have on many occasions awoken to find a) that my neck and head aches (i hate these)and b) my scapular stability (ability to lift my arm out in front of my body, pick things up, open jars) is much worse than the night before. i have spent hundreds of nights on the lounge. i slept on the floor evey night for over a year, with only a 1inch thick mattress.
3) bending down to the ground to pick things up, twisting to get into cars, sitting for long periods
4) putting the affected arm behind my back and trying to reach up my back would be extremely painful and i would lose scapular stability
5) if i had to stand on something that was unstable such as skateboard it would cause muscles in my back and rib cage to go into spasm.


these are the things that i have done that have helped enormously

1) a) taped my shoulder back, this stopped 90% of the funny hand and arm symptoms ( i no longer need to tape my shoulder back apart from one incident when a health professional caused my situation to worsen)
b) i have for the last 3 years worn a shoulder brace made from 2 inch elastic. this has stopped 75% of the muscle spasms in my upper back , the one i use now, i make myself. the brace by itself did not stop the hand problems. when the tape has stopped the hand problems you only need the brace to maintain that situation. the width, positioning and tension is critical. i will try and post a picture of it.
2) one night in 2002 i could feel the neck and head pain starting to happen so i layed on the floor on my chi ball between my shoulder blades. it was late at night and to make it more comfortable i got my special pillow (a pillow that the pt suggested which has a longitudinal divide in it which, for a reason that i dont know, it is much better than a normal pillow) i fell asleep on the floor. when i woke up in the morning i didn't have the horrible neck and headache that i had had for most of the previous 2 years. this in itself is a great thing not to have that happening. the next night to make things more comfortable i used a 1 inch thick sponge mattress that we had. this is a sad thing to be sleeping on the floor and it provided much humour for some people, but who cares i wasn't having those headaches. My hips became really sore to the point where i was limping for the first part of the day. so i got another mattress and placed it on top of the first mattress. but when i made it more comfortable the headaches started coming back. So hipache or headache? we had an OT appraise our situation and she suggested a new mattress, the insurance co. approved. the mattress we chose was made from the hardest industrial rubber available. the mattress co. had never made a mattress from this rubber before. the first morning after sleeping on the new mattress i had the head ache again. in desperation i asked my wife to tape a hard foam block to my spine between my shoulder blades for when i was sleeping. To cut along story short i now have one of those gel wrist supports folded in half and fixed to an old elastic shoulder support positioned between my shoulder blades and i dont get the headaches as long as the support doesnt move. i know for absoute sure that those headaches happen when one is laying on ones back and placing pressure on the affected shoulder blade. Take the pressure off of the shoulder blade and the problem disappears. the reason that i wasnt getting the headaches when i was on the floor was because it was too uncomfortable for me to lay on my back. As soon as i made it more comfortable i started laying on my back and putting pressure on that shoulder blade. the other times i have had the headache are when a health professional has done some work on my shoulder or when i have disregaded the pain and used my shoulder when i shouldn't have done so.
3) when one has irritated the nerve (long thoracic nerve, LTN) and the area between ones neck and under the scapula is sore. if one bends forward and down and stabilizes the affected scaplula the increased pressure in the thoracic cavity places greater pressure on the LTN. if one has put on weight and has a bigger belly this makes it even worse. many TOS clinics suggest the TOS sufferers must lose weight and be aerobically fit if they are to be successful in beating TOS. they don say why losing weight is vital to success. i believe it is because if youre overweight each time you bend forward you increase the pressure on the irritated LTN.
I found that i could not sit down and put my affected arm out in front of me (stabilize scapula) without feeling very uncomfortable. As part of my rehabilitation in 2006 i spent some time in an office. i was required to do some work on a computer. this made the hand/arm symptoms increase. the area that i was in was an area that i wished to be employed in the future. a colleague was going to be in late one day so i took the opportunity to try her ergo chair. the difference was obvious. the ergo chair placed my knees lower. their was obviously less pressure on my diaphragm. this caused less chest breathing, less pressure of the ribs on my LTN. i purchased a foldable ergo chair i use it anywhere i need to sit and use my affected arm out in front of me. recently i have been using pulmicort this has stopped the chest breathing which has decreased the pressure on the nerve. you would not believe how different sleeping in ones bed feels when you are not chest breathing.
4) an occupational physician caused a significant reaction (nerological) when he asked to put my affected arm behind back lift it up and then push away from my back with it. it caused a significant set back in my improvement. it is important not to do as have described. most medical people testing ypu want to see what your limits are. at he endof the day they go home and enjoy themselves, you go home and suffer, it is critical that you advocate for yourself.
5) less use of my affected arm means less pressure on the thoracic spine from compensatory rhomboid muscles. dry needling in erector spinae muscles. chiropractic corrections to the thoracic spine. less compromise to the LTN
(by whatever means) use of a hot wheat bag. and importantly the elastic brace mean that i could now easily stand on a skate board without muscles going tight. i dont have anywhere near full scapula stability i am hopeful that non compromise of my LTN will mean a recovery

a whole heap of circumstances and conditions caused me to get scapula instability and then TOS (age. occupation, fitness, inappropriate rehabilitation, reluctance to stop the things that i wanted to do, wrong medication[aspirin induced asthma, that is reaction to NSAIDS] family committments)

it is obvious that it is requiring a whole heap of preventitive measures to ensure that i dont suffer most of the insidious effects of TOS. but no medication would stop those disgusting headaches. Day after Day.

i hope i have helped somone.

hello everyone,
when i was being sent to various health professionals to be assessed they had various techniques for determining whether there was some sort of neural compromise in my right arm. a pt and later a neurosurgeon tried pulling my affected arm down and slightly behind my body to see if i felt anything strange. i did not. i had had days when i could feel pain in the nerve (i know there are three main ones) that run all the way from the end of my hand up my arm through my armpit and up the side of my neck. it was as though someone had a pair of pliers and was pulling the nerve down. this did not feel good. i believed that i was doing serious damage to the nerve.

when my problem was at its worst and I was resting on the floor laying with the chi ball between my shoulder blades (thoracic mobilization exercise or pec minor stretching exercise or as i like to call it long thoracic nerve decompromise) if i didnt use a pillow to support my head i could cause the nerve to feel tensioned, if i had my arm along side my body with my palm facing upwards. this was only with the chi ball between my shoulders. any more than 2or 3 secs felt quite dangerous. my unaffected arm could be positioned anywhere and i could not make the same symptoms happen in that arm . a visit to an insurance doctor showed me what the earlier medical practitioners were trying to do but had been unsuccessful. he pulled my arm slightly forward and down. the nerve felt as though someone was dragging the it out.

in the time that i spent sleeping on the floor (i had less head and neck aches if i slept on the floor) i would often wake up. in the early hours of one morning I put the chi ball between my shoulders as i often did during the day and noticed that there was a difference. i could place my arm next to my body with my palm upwards and the tension was not on the nerve. when i woke up later in the morning and once again there was no tension. frequent testing showed the tension to arrive at between 9 and 10 am most days

quite obviously the tension on the nerve was changing during the course of the day
also changing during the course of the day
pain in my hand and arm
manual dexterity
tingling in my r fingers
pain near my r shoulder blade
scapular stability

when i was not using my arm during the night, the tension on the nerve would eventually release.
when i used my arm during the course of the day the tension would come back.

since my injury, every time i lay on the side of my affected arm, strange sensations down my arm would start. since my r shoulder girdle has been weakened it was as though that side was not strong enough to protect the nerves from being crushed in my armpit. i could either affect the nerve by laying on that side or during the course of the day as muscles became tight
(I was told on a few occasions by PTs and a musculoskeletal doctor that my r pec muscle was tight)

since my condition has improved i cant make the nerve feel tight, i tried it again tonight
see you later regards towelhorse

hi everyone,
8 months into my injury i had been diagnosed with a c5/6 disc bulge and the orthopeadic surgeon had suggested that i have traction on my neck. he organised for the physiotherapist who was treating me to set up a traction kit at my home. i wasn't going to work now because the symptoms were getting worse. i performed the traction religiously. but it did not make me any better at all. it made my neck more sore. i was sent to a professor of neurosurgery. he said that the orthopeadic surgeon had read the MRI backwards. he said that if the c5/6 disc bulge was my problem the symptoms should be on my left side. he said he would write to the orthopeadic surgeon to tell him this. i told the professor of neurosurgery that a treating pt had told me that i had TOS. he told me that TOS was rare and only happened in people with an extra rib. he suggested that i could have a myelogram (an injection of radioactive dye into the spinal column) to see if it was anything to do with the c5/6 disc bulge. i declined, i didnt understand the logic.

i am very interested in cabinetmaking, i had been to night school for 7 years and had studied woodmachining, furniture finishing (french polishing), upholstery. advanced cab making etc. i have an extensive workshop at home. whilst not at work i had many hours to kill. i wanted to do my cabinet making but it made my shoulder worse. i have a radial arm saw. the blade on a radial arm saw "climb cuts" (as you pull the carriage out, the rotation of the blade encourages the carriage to be pulled out even more). using this saw would cause extreme problems. i had told the doctors that using my arm made my symptoms worse.
i needed to cut a small piece of wood. i decided to use the bandsaw. i was aware that if my hand was "misbehaving" that i was taking a risk. i stood in front of the band saw and without even using or even lifting my hand up it started to tingle. this blew me away. i didnt even have to use my arm to make it worse, i only had to think about using it. this is a difficult thing to tell your treating doctor especially if you are expecting them to be supportive of your condition being a physical one rather than a mental one.
months later and my treating doctor had retired and i was seeing a different doctor from the same practice. i had had a pt tell me that when i lay on my back my r shoulder was 2 inches further away from the table than my left one, she had told me that when i put my arms straight up in the air my left shoulder was good put my r shoulder would sit next to my ear. the occupational physician had said that there was nothing wrong with my shoulder at all, weird stuff because i coudnt lay on that side for more than about 20 seconds without it becoming too painful.

one day i worked out that if i rotated my r shoulder blade in a certain way (causing a grating sensation against my ribs) i could make the inside of my r forearm numb. if i did more rotations other symptoms in my hand would occur. if i continued i could make the inside of my shoulder blade feel warm as though it was bleeding ( i understand that the blood would be the same temp) and eventually it would sting so much under my scapula that it was not possible to continue. i showed the new doctor this and he said ah! displaced scapula. this is after i had done about 6 months of gym work to try and improve trunkal stability. protestations of worsening symptoms were met with no pain no gain from the occupational physician. the new doctor told me that with if i put my r arm straight out in front of my body my r scapula went upwards and outwards when it should not. months later i was still not able to control it as i should. a pt tried mirrors but i could not even notice the difference never mind stop it happening. she placed some tape across my affected shoulder blade. i went into the ajoining gym to do my other exercises.
i sat on the exercise bike and looked at the load settings. before i could move my arm i could feel pressure on the tape. i changed the settings and did my pedalling. when i had finished that i wet to the weights to do my light weight curls. before i could reach out to grab the bar i could feel the tape go tight again. evertime i needed to reach out infront of my body my shoulder blade would try and stabilize, but stabilize incorrectly, i didnt even have to e lift my arm just anticipate that i was going lift my arm. the penny dropped. when i stood in front of the band saw all i had done is stabilized my scapula (but stabilized incorrectly) this incorrect scapula stabilization was causing the nerve compromise.

grays anatomy says " the pectoralis minor assists the serratus anterior in drawing the scapula forwards around the chest wall. Acting with the levator scapulae and rhomboids.....
as my proper scapula stability lessened, with arm use my arm symptoms increased,
even when i only anticipated using my arm, if i did not have proper scapular stability i would get arm symptoms.

dr sanders has had great success with the pectoralis tenotomy. has anybody heard his explanation as to why the pec minor is causing compromise where we can only assume that prior to having a neck injury the sufferer did not have compromise under the pec minor. see yu later , towelhose

i am trying to work out how to add a picture

Attached Thumbnails

 

I’ve spoken about how
1) My scapula stability varies (how heavy my arm feels)
2) The tension on my brachial plexus (BP) varies ( the pressure that the pec minor places on the BP, it increases during the day)
3) The strange sensations/symptoms in my arm vary

May I speak about how the muscles in my thoracic spine used to be in spasm in sympathy with these other problems?

After diagnoses of
• Cervical and thoracic spondylitis, which was changed to
• Thoracic spondylitis (the wry neck symptoms subsided but there was an excruciating pain on the rhs of my upper thoracic spine)
• Thoracic outlet syndrome
• C 5/6 Nerve root irritation ( later a neuro-surgeon told me that the orthopaedic surgeon had read the MRI backwards, the disc bulge was on the wrong side )
• Displaced scapula
• Brachial plexus syndrome
• Discogenic pain of the thoracic spine
There was a diagnosis of Myofascial pain of the erector spinae muscles.
The musculoskeletal doctor asked permission from the workcover authority to inject botox into muscles in my back. Strangely when I asked on 3 occasions into which muscle in my back was he going to inject the botox he would not tell me. His colleague said that I had T4 syndrome. T4 syndrome sounds like the RSD which I am reading of in other TOS sufferer’s stories. T4 syndrome is best described at this link
http://www.iaom-us.com/archive/newsl...9/n19-appl.htm
Please notice how they describe that sufferers often are awakened at night suffering symptoms when they are sleeping on their backs. Other activities such as driving a car or reading the newspaper often provoke symptoms. I read this as they are either lying on their scapula or stabilizing their scapula. also notice how they say that the symptoms are similar to TOS symptoms.

In 2004 our financial position (due to my injury) worsened to the point that we decided to sell our house. The house needed some painting to improve its condition. I was unable to paint some of the positions due to my condition, so I had to show my sons how and where. I have previously described how the tension on my brachial plexus increased as the day progressed ( due to decreasing scapular stability increasing pec minor tightness)
If I climbed on the roof which slopes at approximately 30 degrees early in the morning, I could traverse the roof easily without too much discomfort. If I tried later in the day, muscles in my back would go into spasm and would make it virtually impossible to climb around. I believe that pulling on the nerve in one area causes problems in other areas of ones body. Since my condition has improved and I can’t put tension on my BP I don’t have unexplainable pains in my other limbs. I was told that nerves slide in sheaths by PTs. They tried to show me how to do neural stretches. Unfortunately one of these made my condition significantly worse ( a whole heap of new symptoms such as cyanosis and cold hand) I think it is important not to stretch a nerve when it is trapped. The significance of neural tension became more apparent when I saw an article on the slump test.
http://members.optushome.com.au/physio/slump.html
I am sure that if one can stop the source of the problem, then so many of the other problems will go, if they try and fix problems later in the sequence of problems then there will just be another consequence to take its place.
I hope some of this may be helpful to someone. see you later , towelhorse

Up on the roof, the drifters 1963

When this old world starts getting me down
and people are just too much for me to face,
I climb way up to the top of the stair
and all my cares just drift right into space.
On the roof it's peaceful as can be
and there's a world below can't bother me.
Let me tell you now,
When I come home feeling tired and weak
I go up where the air is fresh and sweet.
I get away from the hustling crowd
and all that rat-race noise down in the street.
On the roof's the only place I know
where you just have to wish to make it so
let's go up on the roof.

Towelhorse
you are such a prolific writer...your piece gave me a lot of insight...I agree with you that NHS Doctors aren't diagnosing correctly (sorry bit of a sweeping statement). I too had to do my own research and become my own Specialist.

I was diagnosed with RSI 13 years ago - a compressed nerve in my spine, found by EMG tests done which found denervation and reinnervation in C7 root and mildly in C8.

I was then diagnosed with Arthritis and Fibromyalgia and basically told to learn to live with pain.

I undertook 2 years of Oesteopathy at the excellent European School of Oesteopathy in Maidstone - a teaching school so extremely cheap £5-10 visit. Then physio which helped but only 6 sessions allowed under NHS. Recently I have had Chiropractic treatment followed by more Oesteopathy.

I am still left with a right side which feels like I am unsticking sellotape on the inside, feel like my ribs are stuck. Its like I solidify if I don't keep moving and I have to "crack" myself to get my upper trunk in motion.

I can't fully lift my right arm without compensating with my ribs. I have been told by School Oesteo I have serratus anterior (problem?) and now I have internet - find this is linked with the long thoracic nerve which could explain the feeling of nerves rubbing like trying to light two sticks to make a fire! From this research it seems to be saying the major observation of Serratus Anterior probs is winging scapula (which I have). Would long thoracic nerve be same as thoracic outlet syndrome. If it is - the winging scapula would be your main giveaway. I can relate to heavy arms in early stages of RSI.

You mentioned about exercise with chinese ball inbetween shoulder blades - I use a wooden block in yoga and sit with it pressed on the wall....however...last time I did it I suffered with stiffness for next few days and I like the idea of something that can be altered to suit the person. Where can I get this? Everything in the public realm is made one size fits all - including chairs that are so big your feet can't find the ground.

It could be that you have cross-overs of syndromes, conditions, as I think you've said. You have asked a few points why...but don't want to lose this msg going back to them (new at this tech stuff ha!) but remember you said about sitting. We're told to sit straight but it doesn't work when your bodies out of balance and I think we sit instinctivity in a way to balance ourselves.

I think the main thing is follow yourself, your instincts, listen to your body.

I have tried this technique to help - use two hands. Cross arm in front of your body to opposite shoulder move fingers up halfway towards your ear. With other hand place it on same shoulder so that its like a cup handle.
Move fingers together and out again and together and out....gently stretching the skin and I imagine gently pulling nerve underneath.I found it amazing...and a few hours later I was just stretching out my arm in normal activity and I felt my nerve releasing (it actually felt like I'd been stabbed...I say that not to frighten you...but to illustrate the power of this stretch. From research it seems this is the area the thoracic nerve travels and it gets stuck on the sides of (things!?) and scapula. It is a very powerful release...I made it up myself so let me know if its any good.

From my research I have also learned I have Electrosensitivity which could have contributed to my RSI and I get tired if I am near too much electrical equipment. I am limited on computer, can't tolerate fluorescent lights, Mobiles completely wreck my head. It seems like damage to peripheral nerves could be linked with electrosensitity...that is my belief. It may explain your exhaustion - perhaps keep a diary of incidences of tiredness and note if you used the computer too much or lights or mobiles.

I hope that may have helped. I will come back to forum but need to limit my dose of electricity.
Be extremely interested to know if others with peripheral nerve injury, RSI have a sensitivity to electrical equipment.

Travel with Love
The Slug

Oops just remembered with that technique you gotta also gently stretch your head and shoulder in opposite direction as though you are pulling apart whilst gently guiding this pulling apart with your fingers....you should feel a gentle tingle as in gentle massage as you do this try moving fingers to collarbone and over the shoulder always keeping in same direction i.e. towards ear and towards should - it should be pleasant and very gentle.

The Slug