[mcduane_ie]

Hi


i have recently been diagnosed with suspected Thoracic outlet syndrome for which I have been having symptoms for past 7 years. I had a doppler ultrasound the other day and results are as follows:

On right side the velocity of the subclavian artery was 88cm/s in neutral position with an increase to 226cm/s in flexion.
on left side the velocity in the subclavian artery was 127cm/s in neutral position and increased to 262cm/s in flexion.
Impression: Based on above criteria there is bilateral arterial compression


Should the velocity be about the same on the left and right in the neutral position. Does this indicate anything? ( difference of 39cm/s)
What exactly do the results this mean? Is this serious? Prior to privately getting this ultrasound done I was told to do extensive Physiotherapy. I have also 2 cervical ribs. My own doctor told me that physio could make problem worse and didnt recommend me doing any and to get back to consultant?

After i had ultrasound done I felt really dizzy and spaced out of it, my eyesight was funny and couldn't concentrate on anything.

Today I was at dentist and she did a filling in far left side of mouth. My head was twisted to left slightly and stayed in this position for about 20 minutes. Afterwards i felt so ill, dizzy and my whole body was shaking. Could this be due to compression?

So fed up no one can explain dizziness which realy upset me.

Any feedback would be appreciated.
Thanks

[Jomar]

No sure about your numbers- some of the other members that had that test might be able to help with those.

but found this on the R vs L differences-
[An interesting finding in our study is difference between right and left vertebral arteries in patients younger than 60 year old. We have showed that in young adults peak systolic velocity (PSV) and flow volume (FV) in left vertebral artery are significantly higher than right side. We think that this is because of anatomical difference of right and left vertebral arteries; in right side, subclavian artery originates from brachiocephalic artery but left subclavian artery directly originates from aorta, beside this branching angle of left vertebral artery from subclavian and also branching angle of left subclavian from aorta is more acute than same angles in right side. ]
http://www.cardiovascularultrasound.com/content/7/1/2

What kinds of things were they doing- or having you do, during the PT sessions?
weights or strengthening? stretches, or basic posture work?

Also sometimes the extra c ribs are small or only partial, unless it has been a lifelong problem, something has changed to make them cause the problems.

What kind of work do you do, or any previous upper body injuries, car accident, sports etc?

[mcduane_ie]

Hi

Thanks for your response. i was assaulted at work 7 years ago. I was working on notice board and was hit from behind on right shoulder/shoulder blade. Since then I have had shoulder pain on and off which has been getting worse the past 3 years. however I was also having severe weakness in my arms which i put down to graves disease which i was diagnosed with a year after work incident. The past 3 years i have numerous neurological symptoms. The main ones that are bothering me are;
dizziness
spaced out feeling
blurred vision
eye pain
feel like I am drunk
severe arm weakness
dropping things
clumsiness
unable to do fine motor tasks e.g putting key in lock, doing up zips on clothes

A new doctor eventually picked up on cervical ribs due to loss of pulse on arm elevation. i have not started any physio yet due to conflicting opinions by doctor and consultant( consultant did not see any problem with pulse)

So kindof confused. I am wondering now if doppler results is saying that I have arterial thoracic outlet compression. I am also wondering about what could be causing dizziness and eye problems.

Thanks
Marcia

[SD38]

Originally Posted by mcduane_ie

Hi

Thanks for your response. i was assaulted at work 7 years ago. I was working on notice board and was hit from behind on right shoulder/shoulder blade. Since then I have had shoulder pain on and off which has been getting worse the past 3 years. however I was also having severe weakness in my arms which i put down to graves disease which i was diagnosed with a year after work incident. The past 3 years i have numerous neurological symptoms. The main ones that are bothering me are;
dizziness
spaced out feeling
blurred vision
eye pain
feel like I am drunk
severe arm weakness
dropping things
clumsiness
unable to do fine motor tasks e.g putting key in lock, doing up zips on clothes

A new doctor eventually picked up on cervical ribs due to loss of pulse on arm elevation. i have not started any physio yet due to conflicting opinions by doctor and consultant( consultant did not see any problem with pulse)

So kindof confused. I am wondering now if doppler results is saying that I have arterial thoracic outlet compression. I am also wondering about what could be causing dizziness and eye problems.

Thanks
Marcia

It all sounds horribly so familiar.
Dizziness and eyes probs seem to be an issue for me, especially when my neck muscles are in spasm and tender.......compressing on vessels?????
Restricted blood flow????? I tend to focus on my breathing " belly breathing" when I encounter dizzy spells etc.
I would definitely recommend that you push to be seen by a physiotherapist!
It was because of a physio that TOS was suspected in my experience. Just today I have returned from my first physio appointment since I had my op ( first rib excision- V/ATOS). Almost straight away he picked up on the fact that my Rhomboid muscle in my shoulderblade is a culprit for alot of my pain in my shoulders, back and arms. One second of gentle pressure on this muscle sent my arms loppy.
They know their stuff and triggerpoints throughout the body. Try to see one for advice, exercise/stretching tips etc.
Relax and keep strong!!!!!!!!

[chroma]

More than one person on these forums has had dizziness caused by TOS. I believe that in at least two of those cases in the last year, people have reported that their doctor (probably vascular MD) told them that their subclavian artery (or arteries) were so backed up that their vertebral arteries had reduced or stopped blood flow as well. This sounds like you.

PT is tricky. Some PTs understand TOS and do good soft tissue work. Most do not.

From what I've read, it's fairly common for people with cervical ribs + ATOS to get the surgery to free up the circulation, plus any scar tissue or fibrous tissues resulting from your injury.

My own dizziness was resolved with highly skilled PT, diazepam for muscle relaxant, posture improvements and time. However, my source is RSI and chronic muscle tension, not injury, and I do not have cervical ribs. You may very well need something different than I needed.

HTH

[mcduane_ie]

Originally Posted by SD38

It all sounds horribly so familiar.
Dizziness and eyes probs seem to be an issue for me, especially when my neck muscles are in spasm and tender.......compressing on vessels?????
Restricted blood flow????? I tend to focus on my breathing " belly breathing" when I encounter dizzy spells etc.
I would definitely recommend that you push to be seen by a physiotherapist!
It was because of a physio that TOS was suspected in my experience. Just today I have returned from my first physio appointment since I had my op ( first rib excision- V/ATOS). Almost straight away he picked up on the fact that my Rhomboid muscle in my shoulderblade is a culprit for alot of my pain in my shoulders, back and arms. One second of gentle pressure on this muscle sent my arms loppy.
They know their stuff and triggerpoints throughout the body. Try to see one for advice, exercise/stretching tips etc.
Relax and keep strong!!!!!!!!

Thanks so much for your reply. Did your doctor recommend the operation or was it following unsuccessful relief from symptoms using conservative methods first. My doctor feels that physio will not help as the cervical ribs arent going anywhere. how was your arterial thoracic outlet syndrome diagnosed. Did you have angiogram or doppler ultrasound.

i live in ireland and I get the sense that there have not been many thoracic operations over here and hence the reluctance to even consider this. However i dont feel that they are taking my symptoms seriously and they keep telling me dizziness has nothing to do woth TOS which is contary to what I am reading on web.

Thanks

[SD38]

Originally Posted by chroma

More than one person on these forums has had dizziness caused by TOS. I believe that in at least two of those cases in the last year, people have reported that their doctor (probably vascular MD) told them that their subclavian artery (or arteries) were so backed up that their vertebral arteries had reduced or stopped blood flow as well. This sounds like you.

PT is tricky. Some PTs understand TOS and do good soft tissue work. Most do not.

From what I've read, it's fairly common for people with cervical ribs + ATOS to get the surgery to free up the circulation, plus any scar tissue or fibrous tissues resulting from your injury.

My own dizziness was resolved with highly skilled PT, diazepam for muscle relaxant, posture improvements and time. However, my source is RSI and chronic muscle tension, not injury, and I do not have cervical ribs. You may very well need something different than I needed.

HTH

Just wondering, how exactly does the diazepam work? Have you any side effect?

[mcduane_ie]

Originally Posted by chroma

More than one person on these forums has had dizziness caused by TOS. I believe that in at least two of those cases in the last year, people have reported that their doctor (probably vascular MD) told them that their subclavian artery (or arteries) were so backed up that their vertebral arteries had reduced or stopped blood flow as well. This sounds like you.

PT is tricky. Some PTs understand TOS and do good soft tissue work. Most do not.

From what I've read, it's fairly common for people with cervical ribs + ATOS to get the surgery to free up the circulation, plus any scar tissue or fibrous tissues resulting from your injury.

My own dizziness was resolved with highly skilled PT, diazepam for muscle relaxant, posture improvements and time. However, my source is RSI and chronic muscle tension, not injury, and I do not have cervical ribs. You may very well need something different than I needed.

HTH

Thanks so much for reply. This site is such a great support. Do you think that I should be seen by vascular consultant with regards to my ultrasound results? I elected to get this test done myself due to dizziness and to show that there was definite compression of arteries as I was being told by own doctor that pulse disappeared on arm elevation while thoracic consultant did not find this and said there was no evidence of arterial compression. he immediately dismissed me when I metioned dizziness.
i really want to try physio but am concerned that due to arterial compression that I could in fact cause more damage without first removing these extra ribs??

So confused. I live in ireland and feel that the expertise is not here and that they will wait until there is serious unreverseable damage before considering surgery. I feel that over here it is not a preventative approach that is taken. I was not told how long to give the physio to see if there is relief from symptoms which is strange. Also I have rang a number of physios and some have never heard of cervical ribs and most have never dealt with TOS.

Thanks so much for your support.

[SD38]

Originally Posted by mcduane_ie

Thanks so much for your reply. Did your doctor recommend the operation or was it following unsuccessful relief from symptoms using conservative methods first. My doctor feels that physio will not help as the cervical ribs arent going anywhere. how was your arterial thoracic outlet syndrome diagnosed. Did you have angiogram or doppler ultrasound.

i live in ireland and I get the sense that there have not been many thoracic operations over here and hence the reluctance to even consider this. However i dont feel that they are taking my symptoms seriously and they keep telling me dizziness has nothing to do woth TOS which is contary to what I am reading on web.

Thanks

Hi there, first of all.. hope you are well

Op was recommended by the surgeon due to thrombosis risk but ultimately the decision to go ahead was mine. Basically the risk of a thrombosis was enough said!!!!
My venous and arterial compression was picked up on both Doppler and Angiogram tests so as far as I was concerned action was needed to be taken.
However initially it was after a visit with a physiotherapist who did the Roo's and Adsen's test on me and picked up that I had the telltale " white hands"..... No bloodflow or radial pulse in various positions.
Can I just mention that prior to this appointment I had been backwards and forwards to my GP's who had made no connection what soever with my collection of symptoms that I had mentioned to him for over 5 years.
Unfortunately my TOS life is not over despite the op as I have ongoing issues with skeletalmuscular stuff in the thoracic region and neuro stuff too...... but on a positive note..... no arterial compression on my right side. It's just a bummer that I suffer venous compression on both sides, so eventually my left side will need doing.
At the moment I'm trying to concentrate on post op recouperation before undertaking another op. Obviously if I experience serious probs with my left side than I will get it done.... sharpish!
I do not have cervical ribs but my space there is still tight and needing freeing up. Apparently on my first op, everything was taken... the whole first rib and some extras. Technically my artery and vein on my left side should be laughing.......all that space!
Anyway..... regarding your doctors comments of TOS and dizziness not linking--------- Just show them this forum. Plenty of us can vouch for it!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Me personally..... I think that they are 100% wrong and ignorant to say that to you.
It's a VERY real connection.
Stick to your gun's when explaining your symptoms.... you know better than anyone what you are experiencing.
Test yourself, if you feel the mentioned symptoms like fatigue or get white hands than I suggest you see a Vascular consultant.
Do the Roo's test, click on the youtube link below.... apparently you should be able to pump your hands for 3 minutes ( I DON'T THINK SO! Not if TOS is in question)
Click on the image on the top left hand corner.
http://uk.video.search.yahoo.com/sea...ff&fr2=piv-web


BEST WISHES mcduane, keep strong!

[mcduane_ie]

Originally Posted by SD38

Hi there, first of all.. hope you are well

Op was recommended by the surgeon due to thrombosis risk but ultimately the decision to go ahead was mine. Basically the risk of a thrombosis was enough said!!!!
My venous and arterial compression was picked up on both Doppler and Angiogram tests so as far as I was concerned action was needed to be taken.
However initially it was after a visit with a physiotherapist who did the Roo's and Adsen's test on me and picked up that I had the telltale " white hands"..... No bloodflow or radial pulse in various positions.
Can I just mention that prior to this appointment I had been backwards and forwards to my GP's who had made no connection what soever with my collection of symptoms that I had mentioned to him for over 5 years.
Unfortunately my TOS life is not over despite the op as I have ongoing issues with skeletalmuscular stuff in the thoracic region and neuro stuff too...... but on a positive note..... no arterial compression on my right side. It's just a bummer that I suffer venous compression on both sides, so eventually my left side will need doing.
At the moment I'm trying to concentrate on post op recouperation before undertaking another op. Obviously if I experience serious probs with my left side than I will get it done.... sharpish!
I do not have cervical ribs but my space there is still tight and needing freeing up. Apparently on my first op, everything was taken... the whole first rib and some extras. Technically my artery and vein on my left side should be laughing.......all that space!
Anyway..... regarding your doctors comments of TOS and dizziness not linking--------- Just show them this forum. Plenty of us can vouch for it!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Me personally..... I think that they are 100% wrong and ignorant to say that to you.
It's a VERY real connection.
Stick to your gun's when explaining your symptoms.... you know better than anyone what you are experiencing.
Test yourself, if you feel the mentioned symptoms like fatigue or get white hands than I suggest you see a Vascular consultant.
Do the Roo's test, click on the youtube link below.... apparently you should be able to pump your hands for 3 minutes ( I DON'T THINK SO! Not if TOS is in question)

BEST WISHES mcduane, keep strong!

Thanks so much, I feel a little better already through your support.