[QUOTE=nospam;884679
Dr. Ahn and Angle were unimpressed that my scalene block was negative as they felt it was not a reliable indicator for surgery. My problems turned out to be my ribs and not my scalenes. I wish I would have learned more back in 2010 when I failed the scalene block and I thought I didn't have TOS.[/QUOTE]

Dr. Ellis doesn't do scalene blocks. When I saw him, he offered heparin injections in key trigger areas. They were not areas which needed to be done under guidance.

Marc: Since your scalene block was unimpressive, did Ahn or any other surgeon suggest the Collins MRI and if not, why?

JKL: Has anyone wanted you to have this MRI as well? I'm mostly curious as his Northern CA counterpart's study is viewed as solid info. The geographical differences in diagnostic testing makes TOS all that more frustrating. Good luck to you with Ando. I hope you find relief and answers.

I was told the same. I've had a cervical epidural as well as a cervical facet block. For me, it was because I had a bulging disc. However, the epidural did not help at all, the facet block helped for 1 day and because it helped I had a nerve ablation (burning of the nerves although they grow back in a year or so). The ablation did not help that's why I don't believe blocks are always reliable.

When my scalene block with Dr. Vernon Williams was unsuccessful (2010) I was never able to get back in to see him. I was suffering and his office only offered me an appointment 6 weeks away. My wife and I assumed that I did not have TOS. I sought out a new neurologist and neurosurgeon. There was evidence of cervical radiculopathy and I went through with cervical fusion surgery which was successful in eliminating many of my symptoms.

In the year following the fusion, some of my symptoms did not disappear and started getting worse. My doctors were overly thorough in verifying the fusion was successful. I also had another EMG which eliminated carpal and cubital tunnel as well, but had some suspicious C8-T1 readings which could point to TOS.

When I started seeing the vascular guys, they all said that failing the scalene block doesn't mean you don't have TOS. Gelabert wanted me to repeat the scalene block as it is his main indicator for selecting surgical candidates. Dr. Ahn and Angle both felt the scalene block was unreliable and didn't think I needed to repeat it.

I also had the MRI of the Brachial Plexus from Dr. Tsuruda in Pasadena that Dr. Williams had ordered in 2010. It showed neural edema and increased neural signal. Dr. Gelabert said Tsuruda does good studies and there was no need for Collins' study. Gelabert also wanted me to have the SSEP test since it was likely I would fail the scalene block again.

Dr. Ahn completely ignored all of my prior tests and said I had clinical signs of vascular and neurogenic TOS but would not discuss surgical options until I underwent his angiogram/angioplasty. Dr. Fujitani wanted to repeat everything, including my cervical fusion workup so I didn't want to reinvent the wheel with him.

Dr. Angle looked at all of my previous studies but said he mainly relies on clinical evidence as the imaging never tells the full story of what he finds in surgery. Clinically he found evidence of both vascular and neurogenic TOS. At my request (he didn't find it necessary), Angle ordered MRI/MRA which showed evidence of venous TOS with my arms overhead. None of the testing showed exactly what Dr. Angle found in surgery. The costoclavicular space was extremely tight on both sides. My left brachial plexus was fused to the rib. My right rib was in an odd position and was attached to the lung pleura.

Dr. Ando was key to me choosing to go through with rib resection surgery. Originally, I wanted to just do therapy or get scalenectomy only. My previous therapists were never able to get my 1st ribs to lower. In two weeks of trying, Ando was not able to get my 1st ribs to budge. However, he did reveal to me why. The ribs below were pushing up on the first rib (subluxations and torsions). This convinced me that my problem was rib related and not scalene related. My ribs have been easier for Ando to align on the left side since I had the resection. I will start therapy on the right side next week.

[QUOTE=jkl626;884561] he was so-so on a Mac or SSEP test.(Has anyone had either of these? Were they helpful in the Diagnosis? Where did you have them done?I'm particulary interested in the Mac,because my pec Minor is really tight.)

I had a MAC test done in Denver. Before my unsuccessful pec minor surgery with Doc Sanders, he had me get one with Dr. Machanic. Apparently it shows some nerve issues that everyone else misses. Mine was positive.

I had an MRA with Doc Collins and he said that if I ever decided to get surgery, I should go with Doc Gelabert and not Ahn. I told Dr. Angle that and he laughed. He knows all three of the Doctors and said Dr. Collins is an excellent radiologist and knows his stuff. Dr. Angle looked at the report for Collin's MRA and said it was accurate based on his exam with me (I have subclavian vein probs and neuro).

Anne:I had a brachial plexus MRI at Oak Tree in PAsadena It shows Neural Edema and helped my first Dr. Williams confirm a TOS Diagnosis. .I dont know if it differs from Collins or Dr. Werden's I think collins does MRA and other tests as well.Dr. Jordan doesnt think much of the MRI or the EMG/NCV. He relies on physical exam and scalene block to diagnose me. Dr. Gelabart didnt think either the Mac or SSEP was necessary but he did mention that the neural Edema points to the diagnosis. I would just rather do the MAC or SSEP before I do an Epidural or Facet Block when I know I have TOS. But I may have "double crush" symptoms whcih means the disc bulge could be causing some of my symptoms. I am going to make Dr. J look at my cervical MRI again since he is also a neurologist and decide what would be next.I also would rather have all the tests before I undrgo surgery if I can get them covered by my insurance. Dr. fish is not on my insurance right now and I dont know if anyone else in L.A. does them

[QUOTE=TOStrojan;884908]Thanks this is all good info. Did he say why to go with Gelabart and not Ahn? That is my gut feeling too. Where is dr. Mechanic? I dont have arterial or venous symptoms so I dont see why I would need an Angiogram or MRA.

So you had Pec Minor surgery based on the Mac test and it didnt work?
Do you think the test is unreliable then?

Did you like Dr. Angle? I cant remember have you had the surgery yet?

Dr. Ando has mention that to me too about the ribs below being a problem. I havent gotten him to let me know if he is able to lower my first rib. I will press him on this. My scalenes were very sore before the botox so I think the injections helped. And my scalene block was positve but I do want to retake it at some pt.as I am the only one not convinced! My worst pain has always been muscle pain Traps,Rhomboids , Scalpular and I'm not sure what causes this. The nerve pain is usually from overuse or overstreching.

Very Interesting. Where is your disc bulge? Mine is C5-6. I keep feeling that there is a connection between bulging discs and TOS. Dr. Jordan wanted to do a Brachial Plexus Nerve Block with Pulsed Radiofrequency to help with the nerve pain in my arm also, but after I saw him last that pain has not been too bad. I didnt go through with it,because I was not convinced and it scared me a little. Also there is not that much research on it.

The Facet block he recommended is for my disc also to see if some of the pain is coming from there. He thinks Cervical epidurals should be the last thing because they are more risky.Did you do the epidural and facet block together? Who did them for you? Did it make your TOS symptoms worse?

This is where mine was done as well, Jay S. Tsuruda was the radiologist and Gelabert knew him and said it was a good study with very clear images.

My neck MRI from August 2011 showed a disc bulge also at C5/C6. But a redid the MRI recently (April 2012) and there was no indication of the bulge. According to my doctors, discs regenerate over time so I guess that's what happened. I had the epidural done first in December 2011. After that didn't help, I did an EMG which came back negative. My doctor said that medial branch nerve damage does not usually show on the EMG so he convinced me to get the facet block (in January 2012) to see if it helps and to confirm his diagnosis for Cervical Facet Syndrome. Because it gave me some relief I did the ablation in February.

The doctor who did these in NJ (as I am from NY). After I went back to him for follow-up to tell him it didn't help, he told me to go to physical therapy (for the second time). I went for 10 weeks and I got worse. So I am not sure if the epidural or block particularly made me worse, or the physical therapy or the combination of all this. But I am much more worse now. But on my follow up after 4 weeks of physical therapy, the same doctor told me I was faking my pain (in better words) and that he had no idea what to do next. The entire time he was also only focused on my neck and told me he did not know where my right shoulder, arm and hand pain or the pain in my occipital lobes was coming from.

The epidural is basically a lot of steroids injected into your cervical spine. The block is usually either a numbing medication, steroid, or a combination from what I was told. Even if you are able to confirm that the bulge may be causing some of your symptoms, I don't believe these procedures can make you entirely sure.

My current doctor is also having me do a block to my brachial plexus (lower trunk). I am going ahead with it next week to see if my cervical ribs are compressing my lower trunk since that is what he believes (and I need some answers).

Let me know if you have any other questions.