I have a question I've been personally researching to try and get answered but have not been able to, hopefully someone knowledgeable like shengggmd can help me out here.

Basically I have a very weird clinical background when it comes to nerve entrapment, while my TOS symptoms are by far my worst and account for 90% of my daily woes, I also have multiple other entrapments that would basically almost never be seen together in one patient, and especially not a 25 year old. I've developed cubital tunnel in my right arm recently, my NCV shows slowing across my radial tunnel, then I have multiple lower extremity entrapments.

Docs suspect I may have something weird/rare going on that would cause entrapment like HNPP, but as of now that hasn't been decided, but if not I just have really bad luck or anatomy :P

Anyways, this has led to my question I'm trying to get answered. In a normal person without typical TOS, would there still be pressure on the nerves as they pass through to the arms, just not enough to cause any problems? For ex, even a normal healthy carpal tunnel has 30 mmHg of pressure, which is no problem for a normal person and they wouldn't have carpal tunnel till pressures reached >100, but in someone with a genetic condition like HNPP (increased nerve sensitivity) even these normal anatomical pressures cause symptoms.

So I'm trying to see if a similar phenomena is possible with the thoracic outlet or pec minor space, do the scalenes and other structures still put some pressure on the nerves in a normal person, or is the nerve nowhere near being entrapped? I mean is the nerve normally pretty tight fit or is it more like a tennis ball going through a hulahoop lol.

They are telling me I need surgery, all the tests for thoracic outlet are positive, but I'm just trying to make sure I don't do anything I'll regret should the root cause of my problem not be so simple. Like I don't want to get my normal thoracic outlet hacked up if it turns out I have something like HNPP, because from what I read surgery doesn't help in these patients.

Hi,
what is HNPP?

P.S. I think you might need to ask a hand specialist not a vascular surgeon. There is someone like that in the Bay Area.

HNPP is a disease where your nerves are way more sensitive to pressure and damage than normal. Basically in someone with HNPP, where problems like TOS and carpal tunnel are a problem of putting too much pressure on nerves from enlarged muscles and tendons, HNPP is a problem where the nerves can't handle the pressure because they are more sensitive. Basically their nerves get entrapped very easily.

Like I definitely have an entrapment at the anatomical site of TOS, but like I said I also have other nerve problems as well to the point I question if my TOS isn't due to some underlying nerve issue like HNPP. I'm tempted by surgery because it's about to get bad to the point that I can't work which isn't an option and my parents health insurance is up on me in like a month, but I also don't want to do anything I'll regret..

So I was just curious to see if a person with an issue like that could have TOS with a normal thoracic outlet, or if that is impossible and TOS could only be caused by conventional means like RSI. There are tons of studies out there showing how things like diabets, hypothyroid, HNPP, and more can cause common entrapment like carpal and cubital tunnel, but I can't find anything in regard to TOS.

Basically I was healthy until I was 25 then within months of each other I developed symptoms of TOS, in addition to numbness in my other thigh (meralgia parethesica, another entrapment like TOS/carpal tunnel but in thigh), as well as burning and numbness in the bottom of my feet when standing (tarsal tunnel), and then a few weeks ago I started having symptoms of cubital tunnel in my right arm.. yea that's what I've been dealing with. Only reason my symptoms don't match up with HNPP is because I don't have carpal tunnel which is found in basically all HNPP patients due to it being the easiest nerve entrapment to get antomically.

The useful sticky thread has some info links about it ( they are from years ago) but a web search will bring up the most recent info I think.

From what I understand, there is something called double crush (or multiple crush) syndrome. What happens is that a nerve that is impinged is much more sensitive further down the nerve. Fix the biggest problem and the others calm down on their own.
For example, I have a minor impingement in my neck and carpal tunnel but it is expected that once the TOS is fixed that my carpal tunnel symptoms will disappear. That's what I've been told anyway. So far, it is not looking like my neck impingement is causing any issues at all.

Good point, I think that might be the case with my right cubital tunnel as well since it just randomly appeared a year after my TOS symptoms started. After talking to my doc about it I've decided to go along with surgery to see if it helps since my symptoms are severe, and the way I understand I've got obvious signs such as loss of pulse with maneuvers that wouldn't be seen if you just had some nerve issue, so hopefully I'm just dealing with classic TOS and this fixes it.

Like it is true that TOS isn't my only problem, but I think I'm being paranoid trying to stick them all together. Worst case scenario, I get the surgery and it doesn't help and I just move on from there with just a few weeks of pain to complain about. Best case scenario I'm cured and I put this whole year of misery behind me and move on with my life (besides posting here with you guys ofc )

I mean my only debate is getting a second opinion, but my insurance has me on a clock since my coverage changes at the end of December, and my doc from what i read is one of the top of his field, Dr Pearl. So I'm thinking just go for it. You guys with agree?