[MightyL]

11 months post surgery and my symptoms are worsening. Started physical therapy and occupational therapy last month at pain rehabilitation clinic. OT has been teaching me techniques to release trigger point tension with theracane and tennis ball massage. OT, PT, and Physiatrist recommend trigger point injections. Has anyone had experience with these? If so, I'd like to hear about it. Also interested to know if you tried trigger point oriented massage first?

MightyL
bilateral TOS
Right superclavicular first rib resection, brachial plexus neuroplasty, anterior scalenectomy, and partial middle scalenectomy

[Jomar]

Was there any scar tissue found during surgery, the surgical report might say & if it was cleaned out..?

11 months could be regrowth of scar tissue, if you were doing fairly well and now sx are increasing.
Is therapy addressing upper body posture, if some posture issues that can be a factor in pain & trigger points.

I did the self TrP/posture stuff and my chiro did adjustments (& top rib mobilization), but also used ultrasound, IF stim, low level laser.
He also did a NIMMO technique, kind of a mix of deep tissue and trigger point that really helped to release severe spasms in my scm & scalenes.

Did/do you have more nerve or vascular type of TOS?

If you can list out your symptoms & where they are we might be able to better suggest things.

some helpful links-
http://www.pressurepointer.com/pain_reference_chart.htm
http://www.selfcare4rsi.com/rsi-articles.html

[MightyL]

Thanks for your thoughtful response, Jo*Mar. PT might not be familiar with the particular framework of say, NIMMO, but might be applying elements in her approach. I'll read up about NIMMO and the other treatments you mentioned and then talk with my PT. I know where to go if I've got questions, now. Thank you!

Hope it's not regrowth of scar tissue as implications could be long term. I've answered your questions below and welcome any further suggestions.

Report says dense scarring within the brachial plexus was removed. Upper trunk was less scarred than lower trunk.

My sx never really got better after surgery. With the exception of chest pain and hand pain from surgery all other sx have gradually worsened especially since early June flare up following exercise on an elliptical (no upper body) with slightly increased resistance to get my heart rate up. My sx include:
-numbness, pins and needles, and pain in right hand especially Digits 3-5
-pins and needles radiating from elbow and wrist when chopping veggies sometimes accompanied by sharp pain in wrist
-pain in right neck and shoulder (biofeedback shows lots of activity/spasm? in right trapezius at rest)
-pain and tenderness in right chest/pec area

Left shoulder blade, scap, and upper neck pain is increasing too, but right side is most debilitating.

As for tx, pain and symptoms generally increase from sitting. So, we're
working on posture and use of pillows in OT to decrease sx in seated position. Just started biofeedback. Also using ice massage 3xday to release muscle tension in trapezius.

PT has focused on neck tension and joint mobility. A combination of gentle stretches, electromuscular stimulation, and mechanical manipulation (stretches and adjustment) has opened up C1 &C2 joints. Mid cervical region is still really tense.

Lastly, I've got neurogenic TOS with moderate arterial compression. Just had a follow up CT/angio to confirm decompression.

Anyway, pain management team (OT, PT, Physiatrist) all recommend trigger point injections as a way to get the trapezius to calm down and clean the slate, so to speak, for retraining. I'm under time constraints as I'm hoping to resume grad school in September, which involves a counseling internship and significant chair time. So, I like the idea of a jump start.

This is lots of info, I know. I welcome your and others responses to any bits and pieces.

Take care,
MightyL

[QUOTE=Jo*mar;1001800]Was there any scar tissue found during surgery, the surgical report might say & if it was cleaned out..?

11 months could be regrowth of scar tissue, if you were doing fairly well and now sx are increasing.
Is therapy addressing upper body posture, if some posture issues that can be a factor in pain & trigger points.

I did the self TrP/posture stuff and my chiro did adjustments (& top rib mobilization), but also used ultrasound, IF stim, low level laser.
He also did a NIMMO technique, kind of a mix of deep tissue and trigger point that really helped to release severe spasms in my scm & scalenes.

Did/do you have more nerve or vascular type of TOS?

If you can list out your symptoms & where they are we might be able to better suggest things.

some helpful links

[Jomar]

I know some of the other members here have had injections , so I hope they will have time to share what they know.

You can also do a forum search (link in my siggy) for more info until there are replies.

Unfortunately the nerves are tricky to deal with.

Does PT suggest laying in a yoga type corpse pose, for relaxation and very gentle stretching? Diaphragmatic breathing etc?

https://www.google.com/search?q=Diap...w=1360&bih=670

[jkl626]

Hi Mighty,

I havent had surgery but trigger pt injections have helped me along with PT.It can relax the muscles so that PT is more effective. I was getting them once a month for awhile. Certain areas respond better than others. when I get them in my trapezious it triggers nerve pain, but they work well under my arm and shoulder blade.

It sounds like you have a good PT/OT team-I think you should take their advice and try them. They should use ULTRASOuND guidance so they know where to put the injections. Good Luck. Where are you located?