!
Jo- here it is:


An Excerpt from Sharon Butler's Thoracic outlet syndrome treatment book:



The Tape Trick is a very simple and low cost way to find out if you are
unconsciously raising your shoulders and perpetually irritating the nerves,
muscles and connective tissues of your neck, shoulders and arms. Here’s
how to do it:

Go to the pharmacy and purchase a roll of non-stretchy bandage tape
that is 1/2 inch in width. Avoid paper tape as it tears too easily. Good old
fashioned bandage tape that is found on the metal roll is a great one to
choose. Tear off a piece that is 12 inches long. Now go find a friend to
help you.

The Tape Trick works best if you do it on one shoulder at a time. Pick the
side of your body that has the most severe symptoms of repetitive strain
injury. If you can’t tell which side is worse, then pick the side that is your
more dominant side. For right handers, that would be your right side.
Have the friend stand next to you, looking at your side. Remove your
shirt. Ladies, it is very important to slip your bra strap off of your
shoulder. Make sure that your shoulders are down and relaxed and that
you are looking straight ahead. Have your friend apply the tape to the
bare skin of your shoulder, in the same direction that a bra strap would
go, with half of the tape extending to the front onto your chest, and the
other half extending down your back onto the back of your shoulder. For
ladies it is important that the tape is not applied in the exact same area
where your bra strap lies because your body has become somewhat
unconscious to feeling pressure in that spot. Instead, have your friend
apply the tape about 1/2 inch closer to your neck.

Now your job is to get dressed and go about your normal daily activities.
If you raise your shoulders at all, the tape will pull on your skin, alerting
you to the fact that you are raising your shoulders. It is important to try
to recognize when and under what circumstances you are habitually
raising your shoulders. By recognizing when you are engaging in this
unconscious activity, you can choose to change it, and relieve your body
of untold amounts of unnecessary strain and compression.
Freely share this Tape Trick with all your friends and colleagues so they
can be on the road to less pain and stress too!

hello everyone ,
I have attached some pictures of some of the things which have given me assistance to improve my condition. When I was at my worst I was laying down or resting for 18 hours a day suffering all the symptoms of TOS. Currently I am working 3 days a week at one place, I day at another, attending college I night and usually college I day. Previously evenings were terrible (as though I was recovering from an auto accident) now as long as I don’t do any thing dumb, they are really good.
I don’t know what order in which the pictures will appear.

Picture 1 chi ball, deflatable to suit the user, you can see the stopper. The size is critical it must fit between your scapula. I use it to take pressure off of the nerve that goes under the scapula. not for pec minor stretches or chest wall stretches. Any similar sized partly inflated ball will suffice.

Picture 2 foam cylinder, I use this 1) all the time if I am sitting in a lounge chair, between my scapula so as to ensure that I do not push the affected scapula against the chest wall. 2) if I am laying on a soft mattress, once again it protects the scapula. 3) when in a car seat

Picture 3 ERGO Chair, sitting in this chair places less pressure on my diaphragm which in turn allows a cycle of breathing which places less pressure on the nerve which runs under my scapula. I take this to both my places of work and it gives me greater capacity to sit and use my arms out front of my body, for instance working on a computer. Since I have been using the pulmicort and my breathing pattern has changed I have a greater tolerance for a normal office chair, but I use the ERGO chair if it is available.

Picture 4 laptop table. Sitting at a desk and using a computer was impossible for more than 20 mins or so. Muscles would wind up in my upper back and arm symptoms would happen. 2 and a half years I was starting an OHS course where I needed to use a computer. I borrowed my brothers laptop (notebook) and found that I was able to use it in various positions. The table can be adjusted so that I can lay on my bed with a chi ball between my shoulders and operate the laptop comfortably.

Picture 5 singlet (vest) with a hard foam block sewn on, to wear when sleeping in bed. You may be able to see where it was originally taped on. The size and shape of the block would need to be adjusted to suit the user. The critical factor is, that it must protect the scapula from being pressed against the rib cage when asleep. I wake up with 95% less neck and head aches when I use this. Significantly when my wife bought a new lambswool underlay for our bed. I woke up with the neck ache, I had to increase the thickness of the block to ensure that the block was not being completely absorbed by the soft underlay and therefore not being effective.

Picture 6 and 7, hook of shoulder brace. Previously a professionally made shoulder brace had been supplied which made a small improvement to the muscle spasms in my upper back. I worked out that the critical factor was how much pressure down, not how much pressure back. The part of the professional brace which travelled from my lower back to my upper back was not made of elastic material therefore could not exert constant tension as I bent forwards and backwards. As soon as I made and used the style of brace displayed there was a reduction in upper back spasms. I wear the brace all the time apart from sleeping and showering. I have a few braces. The one displayed is 50mm or 2 inches wide. I tried making one from 3 inch wide elastic. It would not fit on top of my shoulder or alongside my scapula as it needs to. The hook with the black webbing attached was removed from a small pouch and then sewn to the elastic. The hook allows easy removal from a belt worn in trousers rather than feeding the elastic around the belt each time. I wear the elastic under my shirt. So that I can wear a shirt tucked into my pants I now wear a pair of short pants under my pants. The short pants have a horizontal strap at the back. The hook fits onto this strap.

Picture 8 (me wearing the black t shirt) the elastic strap is hooked onto my belt, the two legs travel upwards with a leg positioned either side of my neck. The two legs are stretched under each armpit, the elastic once again travels around to my back and then to the front where the two ends are fixed together using Velcro (hook and loop). The tension fore and aft can be adjusted by stretching more or less of the elastic from the back to the front and vice versa at the top where it travels past ones neck. The effectiveness of this brace is very much dependent on 3 things.
1) The width of the elastic
2) The tension of the elastic
3) The band must travel upwards close to the spine and not be on the scapula at all. I find myself often adjusting the top of strap closer to my neck and away from my scapula.

Picture 9 taping the point of the shoulder back. Modesty precluded this 50 year old man from modelling in this picture. I thank son of towelhorse for volunteering.
As you can see it is not the same as the tape trick. I believe I have described in an earlier post the circumstances in which a pt first used the tape on my shoulder.
The tape is 11/2 inches wide. It is strapping tape that sports people use. It does not stretch. In the picture I have shown the other tape which I had to use under the strapping tape to protect my skin from the strapping tapes effect on my skin.
I am to the point now where I have only used the tape for five days in the last 15 months. These5 days were due to a medical professionals intervention which caused a negative effect on my scapular stability.
The intention of the tape is not for one to be able to detect movement of the shoulder blade upwards (although as the day progresses one can feel more and less tension on the tape) the aim of the tape is to stop ones shoulder from moving too far forwards. When my shoulder was held back with tape, the symptoms in my hand were only approximately 5% of what I had without the tape. I believe this to be because when one moves the shoulder forwards the serratus anterior is supposed to be controlling the scapula with the pec minor. If the serratus anterior is weak then the pec minor has greater influence than it would normally have and therefore it compromises the nerves under it. Anyway that’s my theory and until someone can come up with a better one I am sticking to it.
I would normally wear the tape for up to 5 days. Please be careful of dermatitis.

My improvement has been slow but steady. Just as there were many factors which contributed to acquiring TOS there have many conditions and circumstances which have not allowed my body to get better. It has been as though there is a threshold through which one must pass before the body can heal. Wrong diagnosis, wrong treatment, reaction to medication, need to use ones arm, secondary conditions, family pressures have all made it very difficult. If my information can help anyone, it is wonderful.

I just remembered something. A treating PT had said that my lower trapezius was weak on my affected side. This she said, was why my scapula was moving upwards. Where as many lower trapezius exercises had been unsuccessful in retraining my scapula to stay down, within 1 day of taping my shoulder I was able to use my right arm without my scapula going up. But when I used my arm with my scapula down there was a clicking, grating sensation under my scapula. this was not good. ( I believe this to be snapping scapula syndrome)
It became quite obvious that my scapula was not moving up because the lower trapezius was weak but because using the lower trap. caused pain under the scapula.

Hence, why the brace pulling my shoulder down works. The brace pulling down my shoulder means the lower trap isn’t causing the problem I have just described.
Picture 10 pulmicort there is something very strange happening in the diagnoses of TOS. Many persons treating TOS suggest that to get better the TOS sufferer must learn to breathe abdominally as their chest breathing pattern is causing problems. But when you look for at the list of symptoms of TOS sufferers it doesn’t list chest breathing as a symptom. So they are suggesting treatment for something which they don’t list as a symptom. The breathing problem is a major contributing factor in the TOS problem. Mine has been solved with the pulmicort. Much time was spent by PTs trying to re-educate me on how to breathe properly. I have spoken before on how I don’t get as tired, the bed feels like a different bed, the gastro oesophageal reflux is a fraction of what it had become since getting TOS, my chest is not hyperinflated and I am not hurting the nerve under my scapula as easily as I could prior to taking the pulmicort. Good luck and goodnight. towelhorse

Attached Thumbnails

         

these are the other pictures. i was restricted to only 5 jpegs

Attached Thumbnails

         

hello everyone,


this is the flow chart that I tried to display before.

[U]An existing theory of how neural compromise might happen down ones arm[

Forward neck posture
Or trauma to neck
Poor posture
v
v
v
stiff neck
Scalene muscle spasm
v
v
v
Brachial plexus compromise
v
v
v
Symptoms in hand
Heavy arm feeling
v
v
v
muscle imbalance in shoulder girdle
SERRATUS ANTERIOR
WEAKNESS



My theory of how neural compromise happens down my arm

Stiff neck
Scalene muscle spasm causes partial
compromise of long thoracic nerve
v
v
v
SERRATUS ANTERIOR WEAKNESS
Caused by long thoracic nerve compromise
Scapular instability
Resultant poor posture
v
v
v
Muscle imbalance
PEC MINOR SYNDROME
v
v
v
BRACHIAL PLEXUS COMPROMISE under pec Minor
v
v
v
Forward head posture
(To minimise pressure On BP ones head moves forward)




as you can see, all I have done is rearrange what are perceived as symptoms and made them causes, and vice versa

towelhorse,

It makes a lot of sense. I agree the head forward posture is an attempt to relieve the pain and pressure on the b.p., I never noticed it prior to my injury.
My TOS was a result of acute trauma (vaccine reaction), but I was pre-disposed by my body - short, so I've spent my entire life reaching above my head, thin, narrow chest and long neck, plus an "extra" scalene, scalene minimus, draped all over the brachial plexus and extra tight under the subclavian vein.

One of the first noticeable sx was a drooping right shoulder - the long thoracic nerve was affected, weakening the serratus anterior muscle dramatically. I've always felt if there was a way to lift the shoulder back to it's proper position, the nerve compression would be resolved. But other than strengthening exercises, which have only made me much worse, I haven't been able to figure out how to accomplish that. I have, at a neuro's suggestion, trained myself to carry that shoulder level with the left, but this in turn creates issues with muscle fatigue and additional trigger spots - but it does relieve the pain of the shoulder girdle's weight resting on the plexus. When I'm seated or in bed I try to relax the arm and prop it on pillows. It's sort of a Catch-22 situation.

One thing to remember early on in the process is when there are scalene muscle spasms, you are also going to get brachial plexus involvement (TOS) - you may not feel it that soon or see the symptoms as it can take a while to develop, but if the scalenes are irritated then the nerves of the brachial plexus will be affected as they pass among them (they should "glide" freely).
Sensory nerves are affected sooner than motor nerves.

Thanks for sharing - got me thinking!
beth

hello everyone
When my symptoms were worse, evenings were bad. Muscles in my upper back would become very taught. If I was unable to avoid using my affected arm, the rhomboids where they insert into the thoracic spine would be really sore, rotator cuff muscles would be painful, muscles between ribs would be tight. I would go to bed hoping that there would be less pain in the morning. But lying in bed would be uncomfortable too. The uncomfortable feeling lying in bed was hard to describe. If I lay on my affected side my arm would go to sleep, if I lie on my other side it would feel like my shoulder was going to pop out. If I lie on my back I would get a sore neck and head ache. But there was something else, there was a feeling that continuing to lie there was doing some damage to some nerves. On a few occasions I awoke and while I was in a state of semi consciousness I could feel a pulsing feeling in my upper chest on the affected side and slightly into my arm. I had had this same feeling when, in the weeks after first injuring myself and I was still fitting roller shutters, if I lifted the roller shutter up to my chest and I was about to lift it above my head to fit it into the guides I would feel a pulse, pulse, pulse in the space between my chest and my arm.

Back to the semi conscious state, it was strange because the pulsing feeling would disappear if I tried to move. It was similar to awakening and hearing oneself snoring for a second or two but then when conscious, you adjust something to stop snoring. It was the same with the pulsing, waking meant something changed and the pulsing disappeared

What I have worked out (in my situation ) is that there was a cycle. When I lie in bed at night I was compromising the nerve which goes under my scapula and therefore when I woke up in the morning I would often have less scapular stability than the previous night. Then I would need to use compensatory shoulder muscles to stabilize my scapula during the day. However these muscles were not made to stabilize my scapula in this way so they became very sore. So by the evening my upper back and rotator cuff would be painful, so it was a relief to go to bed, but I couldn’t sleep because even though I was resting the sore muscles I was now compromising the nerve under my shoulder blade again which meant that the compensatory muscles were going to be even more sore the next day. Just to make matters worse as part of my rehabilitation I was put onto a gym program to strengthen my shoulder girdle. I tried to tell the rehabilitators that I could make the situation better if I put my affected arm in a sling. They said this could lead to frozen shoulder. I don’t think that they had any appreciation of the direction in which they were taking me. They would only see me for an hour every couple of days. There were many hours of ygbbcjdujfbbn!!! In between those hours. When I told them that I was having difficulty sleeping at night (in the context of what I have just described) I was given sleeping tablets which of course allowed me to sleep through compromising the nerve which goes under my scapula which meant less scapular stability which meant even more sore compensatory muscles etc.etc.

I have worked out that
1) if I can minimise using my affected arm in the first few hours after waking up I will improve my scapular stability for the rest of the day.(if I use it, it compromises the nerve even more in another way {bowstringing}) these hours are the vulnerable hours.
2)if I didn’t have to sleep I would probably have not become worse like I did.
3)the sooner I but my shoulder brace on for the day the better I will be

best wishes, towelhorse

In some of my earlier posts I have been critical of some of the aspects of my rehabilitation. Some of the reports of my condition have been outrageous. There has been a willing audience for the comments of this disingenuous swill. As a consequence of my injury being a work related injury, my integrity has been questioned regularly.

Much of the mental anguish that is suffered by injured workers is due to the fact that so much of their efforts are spent defending their credibility. After receiving dodgy reports, injured workers exhibit signs of distrust even with when they visit medical practitioners who will report truthfully.

The poor treatment of persons with conditions which are not completely understood guarantees an outcome that will be less than the optimum.

At my workplace a co-worker has developed asthma due to exposure to western red cedar wood dust. There has been much conjecture as to the validity of his claim. He has not kept his asthma under control. I could see how it might show that his claims were truthful to himself and to others if his breathlessness was evident. I could see it in my co-worker I wondered if I was exhibiting the same behaviour. I did things that perpetuated my condition.

Whereas it is completely understandable that someone with a disputed condition might behave in a defensive way, this behaviour is not conducive to getting better.
I found that I received a more welcome response to my comments of “feeling good when I wasn’t suffering from xyz symptoms” rather than saying “xyz symptoms are really bad”. This shouldn’t have to be the case, but it is the reality.
Somehow one has to break the cycle.
I wish you luck. Regards towelhorse

Yes - many here have and still are going thru the comp system.
The whole system stinks.
Denials right from the start.
Not even a few months of accepted and proper treatments with time off to try to heal.
Lying or just plain dumb IME Dr & reports.
Lazy comp attys that only want to get the $$% of a settlement and not do any real work for the claimant.
Plus-
So many of our own drs that won't admit that they don't know what the heck is really wrong with us - when they should just admit the don't know and refer us to someone that might know or try to learn about it.


my vent about that!

whew

I have found using tape a very helpful way of controlling pain by realigning my posture its hard not to depend on it

I mentioned previously that my diagnoses have been
• 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
• Myofascial pain of the erector spinae muscles
• Chronic pain syndrome
• T4 syndrome
• Partial palsy of the long thoracic nerve

And that 1 neurosurgeon offered a myelogram that would lead to surgery on my spine, if they found something untoward and another neurosurgeon offered an operation where he would resect part of my scalene muscle but I was told that there was only a 30% success rate. And another doctor sought permission from the workcover authority to inject botox into muscles in my back.
It occurred to me that where I was consistent with the reporting of my symptoms and the actions which exacerbated the symptoms, the medical system was not consistent in its assessment of my condition and the interpretation of my symptoms. This led to much frustration. As you may have gathered I try to be specific, but the doctor’s reports ranged from “loquacious” to ”he describes some days as good days and some as bad days and can’t give any reason for the fluctuation”. I can assure you that I did give reasons for the fluctuations, and those reasons were “ when I use my affected arm I get tight muscles in my upper back and strange sensations in my arm, and when I put it in a sling it improves markedly.
For crying out loud the provocative tests for TOS are using the arm in ways that require extra scapular stability. Is this the biggest joke in medical history. Could TOS be caused by someone losing scapular stability and the symptoms are as a consequence of the other scapular stabilizers compromising the nerves that go down ones arm and the poor posture that they notice (after the event) is also due to poor scapula stability, and when they send someone on a shoulder girdle strengthening program they are only causing the other scapular stabilizers to cause more problems.


What if,
You went to the doctor limping and told him that you had sprained your ankle.
The doctor told you that your limping had caused the ankle sprain!!
You tell the doctor that as far as you can remember you weren’t limping prior to having the sprained ankle.
He told you that it was important to walk properly and that you should place your foot flat on the ground as you walk. You tell him that this hurts and you are not able to walk normally.
You tell him that you have a very sore ankle and that your job as a delivery person makes it worse. He sends you to a pt who has seen this condition before, she (sorry about the stereotyping) recommends a truncal strengthening program, corrective breathing exercises and 3 mile per day walk to improve your condition. She tells you to look on the internet to try and make some sense of it all. You see another doctor who tells you that the pain that you are feeling is all in your mind, its called chronic pain syndrome.

Meanwhile your ankle is getting worse, not better. You try and find another doctor and tell them that you have a sore ankle and now it seems also chronic pain syndrome. The new doctor tells you that they have heard that the condition can be caused by depression. You tell them that as far as you can remember you weren’t suffering from depression prior to hurting your ankle and ask them if there is anything that they can do for your ankle.
They tell you that there is an operation that can be performed on your knee that might stop the pain.
You insist that it is your ankle that is sore but now you don’t know what to do. The pain is really bad