My internist referred me to a Physiatrist who thinks I have TOS (I do too), but ordered an EMG. My ins won't cover any b/c of my deductible, and it's going to cost 2800. She doesn't want to give me PT exercises without running a test.
My questions:
1) I really don't want to pay that for a test that from what I've read, may not show the TOS-is that correct?
2) Should I see another Dr? if so, what type?

Here's my symptoms--3 months ago I felt carpal tunnel, changed my computer set up & tried ignoring. It moved up my elbow/ulnar area. I had tingling, numbness, at one point the right side of my face was numb just a few minutes. Now it is primarily my shoulder--by the end of the day it feels "inflamed". I feel burning on the backs of both arms. My hands are cold, and occasionally change color. Most of the tingling seems better--mostly there is a throbbing neck pain, burn in shoulder and back of arms, and headaches.

Thanks so much for any wisdom and for taking time to read

Just wanted to add--my real complaint is the circulation problems I'm having--my hands are freezing and I just constantly feel like my body is not getting enough blood or something. I had a million blood tests, only my thryroid was off (I've been on meds for 15 yrs but somehow my TSH had jumped to 10). They adjusted those meds a few weeks ago, will retest in 4 wks.
Is it worth it to get the EMG?

EMG can be used to rule in or out any possible nerve issue (actual carpal tunnel or ulnar nerve problem) but for most of us it showed normal.

Somewhere it was mentioned that if tested @ C 8 and that shows as slow then TOS is suspect.
My emg/ncv by a physiatrist wasn't tested in that area, and it was before I read anything about c 8.

So I guess a good question would be if that location will be tested or not, and is it worth the $$ to rule out ulnar and carpal tunnel.

Drs like tests, but an advanced PT should be able to do a indepth hands on evaluation for much less money. even separate 2 evals from qualified PTs would be less than the EMG cost.

Have you had x rays or MRI to check for any spinal possible causes of arm pain? these would show any large bony anomalies or extra cervie rib most times.


For a TOS crash course of info see our useful sticky threads- it will really help you out, but you can't absorb all the info at once - just too much of it
http://neurotalk.psychcentral.com/thread84.html

I had an EMG and nerve conduction study here in Boston to rule out any nerve damage. These tests were ordered by a physiatrist that oversaw the PT who treated me at that time. I was fortunate that my insurance covered the costs, but I know that the procedure would have cost about $2,400. As Jo*mar mentioned, my EMG did come back normal. Prior to the EMG, I had chest x-rays. I agree with Jo*mar, another specialist or PT may be able to give you a second opinion which could be of value if you don't want to go ahead with the EMG righ away.

Good luck!

thank you so much for the reply. I have not had an xray or an mri. I did see a PT originally who said a pinched nerve in the neck. When I started having more circulation issues, I went to the Physiatrist (Sports Medicine MD), who suspected TOS. I have a $6k deductible so I was hoping to avoid a bunch of tests. The physiatrist doesn't want me to try any PT exercises until she sees where it is. I have less carpal tunnel systems than at first. Maybe it's time to try another DR--surely they can help with something w/o a test-?

My physiatrist is not willing to show me PT exercises w/o the EMG--is it safe to try another Dr who would--is that normal/acceptable practice? Thanks!

Where are you located? I suggest finding a vascular TOS expert who will at least do a thorough clinical workup for you. I've never heard of PT not treating you without an EMG. Some PTs and Chiros perform the same clinical workups. I'd switch PTs myself.

Eventually, if this is TOS you will not be able to avoid testing IMO. Better to get your deductible out of the way at the beginning of the year and not the end.

Thanks--this helps. The one who ordered the ENG (and won't do exercise without) is who my Internist referred me to--she's a MD who specializes in Physical Medicine and Rehabilitation. I am in the Charlotte, NC area. I guess I will search for a TOS specialist.

The physiatrist I went to & his co location PT place seemed to be based more on rehabbing from acute sports & injuries than a slower appproach that we with TOS need.
They may tend to encourage you to strenghthen before the pain and symptoms are resolved.

We have a Drs & PTs sticky thread at the top of the list that might help you locate someone close.
http://neurotalk.psychcentral.com/thread135.html

Thanks again--I checked the thread but the only one listed in Charlotte has died.
I was heading in the direction of looking for a neurologist--does that sound like the best next step? I haven't found one that states they specialize in TOS, but thought they may be able to discern my type a little better w/o tests.
Sometimes I think I can handle the pain, IF it will eventually go away--but the circulation and strange headaches cause me the most concern/fear of waiting this out. It also seems to be spreading throughout my body--what was once just carpal tunnel is somewhat all over now.