I was recently diagnosed with TOS after suffering for a year with neck and shoulder pan. I also have tiredness in my arm muscles when I drive and numbness in my hands when I sleep at night. I originally was diagnosed with a frozen shoulder with only a minimal deficit in my internal shoulder rotation. I did 6 weeks of PT and have been doing exercises/stretches at home since Feb for this. It brought the pain to a more tolerable level, but it's still there. I have good days and bad days. I've been trying to take it easy, but it keeps me from doing all the things I love. Now that I've been diagnoses with TOS it's back to PT again. I'm not taking any meds. Ibuprofen doesn't help and neither did the Skelaxin I was prescibed.

From what I've read online about TOS a good percentage of people respond well to PT, but the message boards I've been reading paint a different picture of chronic pain. I have a very physical job as an RN. Am I going to have to quit? Is there any hope? I'm leary of the surgery and will only do it as a last resort..

Hi,
It's hard to give a definite answer to that question, there are so many variables to consider.

If you've had x rays & MRIs to rule out any c spine issues & anomalies, expert PT is a good place to start.
It isn't a quick fix, and will take longer if you are still working, but is always worth a good try. Lots of "homework" self care is needed too.

Finding the best PT that you can is the quickest way to see improvements.
Poor PT can set you back and even make you worse, so if they don't work with you and evaluate you at every session to see how you are progressing , or not, and making adjustments to the plan, then they are probably not the best fit.

If in the past you've had any whiplash, sports, falls, hits or other upper body injuries, then perhaps an expert chirpractor or bodywork/alignment type therapy to make sure all is good there.

Those minor traumas over time can cause adheisons and restrictions in the fascia, which doesn't show up in most "tests".
Sharon Butler explains the role of fascia very well.
www.selfcare4rsi.com explore her whole site.

We have many threads and posts , and our useful sticky thread is full of info and various therapies, links to polls & saved posts.

What is your avg pain level without meds?

I did have an MRI of my c-spine. I have some disc degeneration, but nothing that would cause my symptoms. I've had x-rays done as well. No extra cervial ribs. No history of trauma. I had a doppler study done that basically shows I loose my pulse on the right side with my arms at 90 degrees, 180 degrees and in military position both looking straight and to the left. If I sleep on my stomach with my arms above my head I basically wake up with a "dead arm". I've stopped sleeping on my stomach all together. I know the best position is my back, but I just can't fall asleep that way.

My pain was the worst back in Feb. I'd say a "8/10" on my worst days. I had a muscle knot the size of a golf ball in my neck/shoulder area that is much smaller, but never goes away. Since doing PT every day for the shoulder and doing some posture correction exercises that my PT recommended I'd say my pain is "6/10" at worst, but that's only if I stretch/exercise every day.

clearly, going back to predecent exercices can bring back symptoms easily.

Personaly at the moment i don't have pain but a boring grip strenght problem. Realy, it seem nothing but it make me sad... It is anoying and frustrating as hell. Yeah, frustrating as hell. i wish to open up the TO myself with a knife sometimes grrrrr

Usually a 5 and up pain level is when sleep quality is affected. Getting good sleep is very important to all healing.
You probably know that since you are a RN..

Does your PT use any modalities to help with pain relief?
Like US, E stim, LLLT, massage, manual trigger point work?
Many of the PTs places I went to didn't utilize all of these modalities, mainly only some stim & US, and some massage to my forearms when they thought I only had bilateral RSIs.

The chiro I found used all of those things plus adjustments.

Seems to me job #1 for PT should be to get pain levels down as low as possible , before implementing the more active therapies that you need to participate in.


*some triggerpoint work you can do for yourself w/ a tennis ball/ dog ball ( or whatever round object that seems to work for you) against the wall or laying on the floor
we have a sticky thread for TrPs also - up near the top of the main TOS forum thread page.

Some of my go to gadgets at home are a
Far infrared heating pad
IF stim (Interferential Stimulation) had a EMS stim before , but IF is soo much better.
Foam roller /Swiss exercise ball - for passive posture help -
see - http://neurotalk.psychcentral.com/album.php?albumid=422

If you are interested in supplements they can't hurt... a multi vit/min , good cal/mag blend , MSM, maybe some grape seed extract..B complex for stress.

We have had other nurses in the past posting with a stretch injury as the cause of their TOS, reaching, lifting, moving, catching pts...

There are a billion bad PTs out there. They may say they know about TOS, but they don't.

There are very few good PTs (see thread: New PT List). I finally found a good one! After so many bad.

She is targeting the area and doing rib mobilization and scalene stretching, etc. She seems to have zeroed right in on it and I have so much hope.

No one else knew what they were doing. And those nerve glides and all that junk, well, it just added.

At least this PT, wants me to never have something affect me bad. No pain, no gain DOES NOT apply to TOS.