I know TOS is often a diagnosis of exclusion with many times the diagnosis coming from one of many physical tests. Curious what tests doctors have done for you and what showed the most positive evaluation sign for TOS.

For instance I can do the "hands up" Roos test with discomfort but can go the full three minutes with only mild tingling present. I feel heaviness more in my shoulders than outright pain. For some this causes excruciating pain. When they depress my scalenes to recreate symptoms I am fine. I am told some are in horrible pain. Same with pec minor.

I ask because I am having trouble isolating where my entrapment exists and palpating the scalenes and pec minor (as of today anyway) do not recreate the symptoms. Anyone else fall into this category?

But seemingly my symptoms are getting worse with more burning and cramping in my forearms. So clearly there is unresolved compression somewhere. Just can't figure out where the problem area is.

Obviously it is harder to diagnose NTOS than vascular. Dynamic doppler ultrasounds are the quickest and least expensive imaging test (also no radiation). The best one I had done imaged my subclavian artery and vein and axillary artery and vein (the one that runs under pec minor) with arms up and down. This was done in both a lying down and sitting position. I also had an MRV and a CT done, but they didn't show anything the ultrasound couldn't pick up. Wish I'd saved myself the time, money, and radiation!

I also had the ultrasound done where they attach probes to the fingertips and had me move my arms above my head and out to the side while sitting up. This was strictly to test arterial compression.

EMGs are notoriously unreliable, unfortunately. From what I've heard from doctors and read on the boards, NTOS is really best diagnosed by symptoms.

As far as clinical tests, I've had strength tests done by both PTs and surgeons (I always fail the "hold your fingers splayed apart and don't let me push them together" test). Most docs have me put my elbows at 90 degrees with forearms up to 180 degrees and turn my head.

Needless to say, I've seen a lot of docs and a lot of PTs. They all rely on my symptamology as a guide in regards to nerve compression. I honestly thing a good PT is the best person to discuss where the compression is. Mine can tell me if it is coming from my rib/scalene area, scar tissue area, or pec minor depending on what she does.

But could you reproduce your symptoms?

Could it be triggerpoints causing some of those feelings?

When my sx show up forearms are the usual place, aside from the achy neck/shoulders stuff.

My forearms are lumpy & bumpy when I rub my hand slowly over the muscles, top is worse- knotty /ropey the PTs called them.

A little bit all the time but worse when I use them repetitively and when neck gets tight.

Been fixing my puter all day today so arms are starting to complain.
means extra home therapy time tomorrow.

Sorry to hear that Jo*mar, hope you dont flare, fixing computers sucks. Thank you for all your hard work and dedication here. I know everyone appriciates all you do.
Jay

Where did you get your tests such as the dynamic doppler ultrasounds?

Dynamic simply means that your arm is placed in different levels, especially above shoulder level. Example would be an MRI of the brachial plexus with arm down, at shoulder level and above the head, not just Laying in one position

I do believe doppler testing is only for veneous and arterial TOS, not the neurogenic variety??? I am correct?

That is my understanding.

I understand that. My question is where did pixified get the tests? I had an ultrasound too but neither the tech nor the doctor understood what was needed for TOS, even after I pointed it out.

@pixified, can you share where you got your ultrasound tests?

My TOS has improved considerably under conservative care, but my circulation still gets backed up in my neck and subclavian area. I would like some quantification of the compression I have.