Hello everyone, new to the forums. Let me tell you my story and get your opinions. This past summer I have started having trouble with my right arm. When I would lay down to sleep on the right side, my arm would start aching, I mean a deep, dull ache that wouldn't quit. Previously I have been diagnosed with degenerative disc in the lumbar area, so I assumed my arm pain was the degeneration moving up to the cervical area. On November 2, 2011 I woke up in pain in my right arm. It was a constant ache that would not go away. Also, I kept dropping everything that I tried to pick up with that hand, the hand and arm was weak as well. I went to the doctor on the 4th and he gave me pain meds, steroids and muscle relaxers. The pain got better 2 days after starting the steroids, but as the dosage tapered the pain returned. The pain was not as bad in the beginning, but it still ached whenever I did something with that arm. Also, behind my shoulder blade hurts, my neck on that side hurts and I constantly have a neck headache on that side. I was sent to a neurosurgeon, did a cervical MRI (which was normal) and had more good days than bad. I have not worked since October 30 of this year due to this pain. I have noticed that I am having more bad days than good now, I will have 3-4 bad days and 1-2 good days. M pain is worse when I have my arm away from my body, such as riding in a car and having the arm on the armrest. I was originally told that it was suspected brachial plexus injury, but no EMG was done to confirm. I noticed this evening that the pain came back on when I washed my hair tonight. I am not constantly in pain most days, usually at night or if I have been cleaning my house and using the arm alot it will hurt. I'm not sure if I have TOS or not, but the symptoms from everything I have read seem more consisten with this diagnosis than with brachial plexus injury. I am still taking Naproxen and pain meds and muscle relaxers, but nothing is really helping.

My symptoms are:
Dull, achy pain in right arm down to my fingers (esp ring and pinky finger)
Positional pain (feels better when I hold my arm against my side)
Numbness
Neck and shoulder ache
Constantly have to wake my hand up (squeezing my hand together a few times)
Weakness
Increased pain when doing stuff overhead or really active
Can't sleep in my bed or flat on my back
Hurts when turning my head to the right side
Progressive pain (getting worse as time goes on)
Have started feelings twinges of pain in other arm as well

Any help would be appreciated, also if you know of any doctors that specialize in this diagnosis in NC would be appreciated.

Thank you for taking the time to read this long post. Thoughts and comments would be most welcome, because at this point I just wish they would cut the arm off. I am tired of hurting and I am so tired of taking pills. I don't usually complain much about pain, but when my hubby saw me crying because I hurt so bad I think he finally understood that I was in pain. Also, how do you exlain to someone how bad you are hurting.

I sounds very much TOS like...

What kind of job/hobbies do you do? Repetitive, desk, hand/arm intensive?
Or even previous whiplash, sports injury, falls, hits, broken collar bone??
Overall upper body postures? Like head/shoulders forward or hunched?

It's often helpful to try to figure out why this started happening for you at this time.

The useful sticky threads will give you a solid start on TOS info/details & therapies.

Are you having any swelling or color changes with arms up vs down?

Yes, taking the pills with no phys therapy is just a cover up -the pills don't fix the problem. If you need then to be comfortable that's one thing. But some expert therapy is a good thing to try.

I am a floor nurse. Constantly lifting on patients and charting on the computer. The only trauma that I have had is wrestling with my 4 boys. No change in arm color. I have asked about therapy, but until I have my EMG on the 19th they don't want to discuss it. The medicine does make me more comfortable when the pain is bad. I have checked out the stickies, this is what made me think that what I have sounds more like TOS vs brachial plexus injury. Is there an appropriate way to broach this diagnosis with the doctor. Most of them don't like it when the pt comes in suggesting something.

Thank you for your feedback.

Ahh, in the past we had quite a few nurses posting, due to lifting/helping pts.

I don't know if you have started a workers comp claim or not, they aren't fun and not easy at all, but if the injury becomes long term/debilitating it might be something to look into. Especially if you an think back to any specific injury happening. Often it is a small thing at the time or a cumulative effect, but the damage happens and the symptoms show up later.

You might consult with some very good work comp attys to see what they think and if you have a solid claim. But many will talk a god game in hopes of an easy %% of the settlement. So research for some quality wc attys in your area and don't just pick one out of the phone book. Most have free first consult.

If you can discretely ask around for a dr or advanced PT that is really into the body and how it works together and is open minded about this kind of injury...
Yep, some don't even like the pt asking "could it be TOS" because they don't know/ haven't explored or studied about it.
been there done that..

Don't know how you feel about chiropractic or maybe an osteopath would work better for you.
expert & experienced is best in general as they may have come across this before.

Often a good PT place will know of drs that might be more advanced in this sort of thing , I wish I had done more asking around at the beginning of my injuries.
Might have saved myself some wasted time.

Maybe ask your dr - "what drsor PTs in the area are very experienced in muscluo /skeletal injuries"?

Don't be surprised if the EMG comes up negative.

I don't know why they can't send you to PT for a in depth evaluation?
Did the dr actually do any positional testing at all for you?
Most of mine only did the usually carpal tunnel test and a few hand strength tests - I didn't even have any carpal tunnel symptoms.

I'm not to fond of drs attitudes & when they won't say- "sorry, I don't know how to help, lets find you someone that might be able to help you."

The neurosurgeon did the grab my finger test, push against me to measure strength. Then he had me lift my arm out to the side while he felt my pulse in that arm and turn my head. Finally, he said that he thinks it is a brachial plexus injury. If no better in 2 weeks call back and they will do the EMG test or nerve conduction test.

My primary care physician sent me to a neurologist for second opinion. He actually did more positional testing. No comments as to what he thinks it is. He said he wants to do the EMG test and go from there.

I do have a question though. As far as the swelling and color changes to the hand, doesn't that only occur for arterial or venous tos? I don't typically keep my arm elevated for any length of time because it causes pain, so if there is any color change I don't know about it.

My dr did say that this could be work related, but there is no evidence or injury that I could point to that may be causing this. One more thing, is there any way to break the pain cycle? Since last night after washing my hair, I have been in a constant pain cycle and nothing is helping. I actually thought about going to the ER for a shot or something but wasn't sure if that would help.

I don't know why they didn't rx PT for pain relief help if nothing else..
ultrasound, massage, electric stim , low level laser - plus if an advanced/spinal PT they can check for minor misalignment's and work on those.
It really is amazing that even small misalignments can set you up for so much pain..
And it is the body's foundation.. so if something is out it takes longer to rehab until the foundation is fixed.

Have you read about trigger points and the referred pain/symptoms they can cause?
those are easy to check for yourself or have someone check areas you can't reach easily.

[swelling and color changes] yes usually - I just asked to be sure.
If you do the "stick em up" and looking in a mirror you would see the hands go white and then when lowed the usually flush pink again.

I wonder if doing the corpse pose would help to relive some of the pain/sx.
Lay on floor or bed - arms at a comfortable position
do the deep diaphragmatic breathing and focus on total relaxation
maybe some soft music to help

Explore Sharon Butler's website lots of articles and explains about "sticky tissues". www.selfcare4rsi.com
-the sticky tissues can adhere to muscles & nerves causing many sx & pain-

often why most imaging /tests come back showing no causes for us -
just doesn't show up on those tests.

I don't talk much to my husband's family about what is going on wiht me. My husband, however, talked to his sister last night about the trouble I was having wiht my arm and back. She suggested that it might be osteomyelitis that was causing my symptoms. Personally, I would think that after explaining my symptoms to 3 different drs and none of them considering this dx, that is probably not what is going on with me. Has anyone else ever heard of osteomyelitis causing these symptoms. I have no fever or feeling of malaise, except when I go a couple of days with little sleep.

Also, I recently noticed that my right hand turns a different color when I am holding it out from my body. It doesn't even have to be above my head, just slightly angled out from my side. It gets darker than the other hand and really white around the knuckles. Anyone else ever experience this and what does it mean?

I've never heard osteomyelitis mentioned before..
Perhaps she had just heard about it recently and jumped to that conclusion.
With second hand information often little things or clarifications can get left out.
I'm sure the doctors would've considered it if it fit the symptoms.

So the EMG showed everything is normal. I asked the Dr what about TOS...his response was that TOS shows up on the EMG and since it didn't I don't have it. Also, TOS occurs in small frame women not large frame women. I am so frustrated. I don't know where to go from here. He said there is nothing else he can do except PT and he is sending me for strengthening. What else can I do? Any Dr's that treat TOS here in NC?

If you read more deeply on TOS, you will find that there are people with TOS whose EMG tests are negative. In the literature they label this "disputed neurogenic TOS", but plenty of TOS specialists recognize it as a real problem.

Medical testing for TOS is not perfect.

Also, I have never heard before that frame size is related to TOS. Even if it were, don't you think it would be a trend rather than a hard rule?

I think you need a 2nd opinion.

Also, be careful about strengthening. Usually TOSers need stretching, myofascial release and light strengthening of postural muscles. As Peter Edgelow pointed out, you have to get rid of the compression and restore circulation before strengthening.

Re: who to see, I'm out in Los Angeles. Hopefully, someone will chime in with East Coast recommendations. You may still need to travel up or down the coast though.

Good luck.