trying not to fear the worst...quick recap:after 4 mos of wrist/arm/shoulder pain, diagnosed with carpal tunnel (on EMG) and thoracic outlet.I've been wearing a wrist brace at night and my carp tunnel is better. NO more bluish/col hand stuff...and can type long enough for work--but the burn is pretty constant in shoulder blade and top of shoulder..ice/heat helps enough.

So far I have had 3 p/t sessions--1x/wk--was trying to get to 2x/wk, but each time, a few hours after, my TOS symptoms are much
worse. I went on Wed this week, and each afternoon since it flares bad. I had to cancel Fri appt. When it hits, I get a burning, like flames, pain under both arms, rt shoulder blade, neck , sides/front of throat, and across my rib cage.

No swelling,color changes, sweating, or numbness--just fiery burning. Lasts a few hours like that. I usually try ice which always sounds awful but will help, and last night I got in a very warm bath, which helped.

Is it getting worse? progression of disease--or is p/t not working? Is it more than TOS? hoping against RSD, but there isn't swelling and I can handle wind, clothes, people touching me, etc...no problem. thanks for your wisdom and time.

The PT is the one that was doing rib mob right away?
Are they doing pain/sx relieving modalities too.
maybe the rib mob and other things + still working 40 hrs a week?? -is too much?

Or PT is just too aggressive for what you need right now?

Sometimes they "have" to show ( boss/manager/Ins) that they are "fixing" you in a certain time frame vs doing what YOU need for optimal recovery.
If that seems to be the case, that PT is too aggressive and/or set in a time frame plan, ask about that, and/or go find another PT place.

Do they ask/evaluate you each time you come in - how you are feeling and make any changes to the plan??
If not, they are not going to work out for you, that's how I see it.

The good places /PTs I saw always asked at the start of session how i was doing ,pain /sx level etc.
then If any increase they focused on ultrasound/massage/heat = pain relief . Nothing else, stretches/or any strengthening stuff was backed off.
That's how good PT should be done IMO.

I hate to say this but....
I will say that I had NO improvement while still working , kept getting worse slowly, even very light modified work (4x 10 hr days too).
But most of the jobs they found/made for me were still hand use and same postures as before only no speed requirement, but I still striped to accomplish the little jobs, I just can't sit around and not do anything when getting paid,,.. and I don't think that was the idea..

My dh employer would have the injured guys sit in an office , full pay, and not have to do anything, to keep them from having to claiming time off work wc monies.

I found my old post that explains part of what happens when working & trying to recover-

[If you are working or still using your hands/arms etc quite a bit it will take even longer to see results.

Sharon Butler explains it with a health bank account analogy -

(you are starting out at zero if your pain/symptoms are high).

you go to PT & rest, so you gain say, 100 dollars in your account { I mean good PT - specific for what helps you to feel better}
but if you drive to work and work and drive home you have to deduct 75 from that account - subtract even more $$ if you hurt more than before you went to work...
plus you would subtract $$ for any other uses that you did between PT /resting etc..

this is just a simple version of her analogy

- but it really made sense to me when I was having PT & still working
and why I wasn't gaining much by way of improvement at the time - but of course my doc, wc and employer didn't take that into consideration.... that some will need time the off to see good results with PT.

All I was doing at that time was going to work, PT sessions and then resting at home with ice/heat on my arms and doing the gentle stretches. My dx at the time was basically RSIs. I didn't know much about TOS til later. LOL if I knew then what I know now... ]
Sharon Butler articles -
http://www.selfcare4rsi.com/rsi-articles.html


So basically you can end up in the hole with $0 dollars in your "use" account then things only do get worse IMO.

When I was working while injured, I basically came home and iced/heat & totally rested, did nothing, actually I couldn't even use my hands for awhile they just stopped working for a short time, pretty bad in the bathroom situations....not much of a life at all for a few months and I still got taken off work as I was not improving..

I hope this doesn't freak you out , but just FYI as how bad it can get.
But I did recover and no surgery but it took a lot of time and luck & self care.
Prayed a lot too..

I would really look at and decide if this PT/place is helping you at all..

I don't know if there are lots of massage , bodyworkers, therapists, PTs or maybe even a chiro or osteopath?? in your area? to choose from maybe try another place?
I'm near a city of 80,000 so many of those places to choose from.

oh you really are such a blessing--an answer to my prayers! just someone who gets it, listens, responds--thank you.

good memory on the previous p/t. my dr called the p/t place and asked for a specific girl and they changed me--i like her much better. the first time i switched to her (my 2nd total p/t), she was very gentle, we did foam roller, and some posture/sitting. no flare after that visit. i went back the next week (last wed) and said I felt some better--i had a lot of hope. So that time she did some manipulation (?) on my lower rib cage/diaphragm--it hurt while she did it--she called it loosening a stuck diaphragm? and then she worked on massage (hard) on my rt shoulder--said that area is still very tight. it felt sore while she did it, then she loosened up my pec muscles. All of that was more muscle-type sore, not nerve pain. But that afternoon--the burning.
The next day I woke and was about a 6, OK, live-able...I did too much. I only tech. work part time, but I do a lot of personal computer stuff, have 2 young kids--and yesterday I really pushed it-wal mart, cooking, laundry--was so tired of feeling useless.

Sorry this is so long! I see from you the wisdom in taking it slow. I really have to rest or I won't get better. Hard to hang on to hope that I ever will...but I do believe I will. And I'll admit I'm learning/growing a lot on the "inside" through all this humbling trail
thanks again--I think I'll talk with her next week like you said and see if maybe she expected this with w she was doing. I do the foam roller like your diagram shows and I so like that.