Hi Elap,
Yes he did, I trust Dr. Donahue with whatever he recommends and with me, we tried everything, injections, PT, injections, injections, and more PT, before going to the surgical route as he doesn't want to rush into anything and it doesn't always work. The nerves can and do take forever to heal, if at all.... I also had a cervical fusion of C 3-7, prior to my TOS surgery. My symptoms did not go away and I am still having symptoms and now have them on my right side which was not my injured side. I have also developed RSD from this injury so things are very tricky. Please don't take it as I am saying your case is not I just know this is a nightmare for all of us to live with daily.

That being said I am a workmans compensation case and I waited for 2 years to have my cervical fusion and 3 for the TOS surgery. I believe that this has had something to do with my results. I am now looking at a right sided 1st rib resection and scalenectomy and to be honest I don't know what I am going to do. I first have to get through the cervical fusion of the nonunion I have on 2/19, and then I will take the next step in this process.....

I wish I had an easy answer for you but as we all know none of this is easy and there is no guarantee, i don't want to mislead you by saying I'm that much better when in fact I am not.
However, I must say I'm sure you have learned that he does not offer to perform the operation if he feels it isn't going to help at all and his success rate is phenomenal so if you trust him I would say some relief is definitely better than none and again, his success rate is pretty amazing.

I'm sorry that I cannot be of more help but I want to be honest.
Please feel free to message me with any other questions you may have and I hope I helped at least a little bit.
Have a great night,
N

Thank you for the detailed response. I'm so sorry to hear about your ongoing pain. Dr. D. is indeed conservative in his approach and I understand is very selective in offering surgery to only those he feels will benefit. I'd send you a private message to discuss further, but this forum prevents this since you have only a few posts. Perhaps you can message me?

Quick Update:

* Officially one week post botox injection. I've definitely seen improvement in symptoms, but to be honest, it's hard to say if it's the botox or not.

My symptoms have slowly been getting better as of 2.5 weeks ago. There's no doubt about that. The pain in my forearm/wrist/hand continues to recede. The numbness is even better today. Maybe the botox will put me over the hump.

Here's what I've been doing religiously:

Deep tissue massage -- to loosen up anterior muscles and allow shoulder to move posterior:

* Pec Minor -- deep massage. Cross friction with a softball on the floor.

* Subclavius -- ditto but with a raquetball on the all.

* Serratus Anterior -- same.

Strengthening -- to pull the humeral head back and down.

* Rhomboids -- Scapular squeezes. I basically will squeeze and hold for 10 seconds. Repeat. I do this when I think of it. Like when making coffee.

* Rhomboids II -- Low cable rows. Will do 15 reps of pretty light weight squeezing and holding for an instant. Will then lower the weight and pull back and hold for 10 seconds.

* Rhomboids III -- Prone cobra dumbell isolations. Use 3 lb weights and hold for 30 seconds.

* Lats -- lat pulldowns.

* Scapular stablization -- Push up holds at various heights. Very very difficult considering that my tricep has 1/3 of the right side's strength.

Hoping to continue seeing improvement. That said, it will not surprise me to take a step back here.

Well, returned to the applied kinesiologist yesterday. His assessment was very positive.

I explained that my severe pain had been replaced by pins and needles and asked him if this was progress and his response was, "well sure it is." He then tested my strength and I had across the board improvement.

It's really amazing. He put me in a "slouched" position and testing strength doing various movements. Noticeably weak. He then had me sit up straight with shoulders back and I had full strength.

He thinks that I need to continue on the rhomboid work.

He also commented on my tricep weakness. Indicated that he thought the compression was for the most part removed and now it's all about regaining strength.

I know not everyone is in my boat, but I do have cervical ribs and I've been through this before. I've never attacked this so vigorously via exercise and massage. The results were pretty dramatic and quick. I know in the past pain prevented me from doing anything. This was a mistake.

All that said, I'm not out of the woods yet and am fully prepared for some kind of setback.

KY

Well, I think...knock on wood...I've beaten this thing for the 2nd time.

As a quick review, I'm a Dr. Donahue patient at MGH and I've experienced two TOS episodes over the last 3 years. I also have cervical ribs. The first episode resolved with a botox shot on the right side. This second most recent episode on my left side is currently 90-95% resolved and due mostly to deep tissue massage, muscle strengthening, and much less due to botox.

In mid-December I started having debilitating pain down my left arm. This is after trying to rehab a shoulder injury for over a year and having shoulder surgery in mid November. I'm convinced that due to lack of mobility and muscle imbalance, my left shoulder became too internally rotated. More specifically, my pec minor shortened and my rhomboids weakened. This all pulled my left shoulder forward and crowded the thoracic outlet area. Worse, the pec minor and scalenes compressed my nerves. The result was serious weakness on my left side. For example, my left tricep probably had 20% of the strength of my right tricep.

After a month of flailing around, making no progress, and considering taking a leave of absence from work, I ran into an applied kinesiologist, David Leaf, down in Plymouth, MA. He debunked the whole idea of TOS and just indicated that had serious strength imbalances and posture issues. I was given a regimen of tissue massage and strengthening exercises. Six weeks later, the pain is 100% gone, I have just a hint of tingling in my index finger, and my tricep strength has increased to 60% of the right side.

I will say that after I started doing David Leaf's exercises/massage, I did have a botox injection. I'm not convinced that this time around it had as much impact as previous. The trending in pain/symptoms had started to decrease prior to the botox injection and continued along the same trendline to the current date. It may have helped me on the margin, but didn't resolve the problem completely as it did before.

I communicate all this because I think you can get yourself out of this mess...assuming your anatomy hasn't been drastically altered by some kind of traumatic event (like a car crash, etc.). I have cervical ribs. I didn't have TOS when I was 20. It's only now that it has emerged most likely to do with postural issues (i.e. daily computer work), my favorite activity (weightlifting), and the fact that I'm 45 years old (and I tend to lie on the couch in odd positions vs. run around in the woods like a 12 year old with perfect posture).

If you're willing to endure some pain and be systematic in your approach, this can be licked.

You can see more detail on the tissue work and exercises within this same thread.

Now I'm hoping I can keep myself out of trouble by sticking with this program on a daily basis.

KY

Ky,

Can i ask how often did you do the posterior strengthening excerisez? 2-3 times week? and how much weight did you use for the rows and lat pull downs? My symptoms are no where near as bad as what other people are experiencing in this thread but , they are hanging around abit. the Main symptoms would be a strong "tightness/pain" type feeling in the index finger of the left hand which is increased when i make a fist or clench the hand.

From beginning to end of your second episode with TOS, how long has it taken you to get it sorted this time around ?

Hellothere,

This started December 20th to be exact. I spent a month running in circles until I found David Leaf on January 16th. From this point until about mid-February things changed dramatically. I'd say 4 weeks this time around (vs. about 2 YEARS previously!)

Here's what I did almost exactly on rowing:

* 4 times per week. All using a cable row machine
* Workout 1: 4 sets of isometric holds. Light weight...about 30lbs on a horizontal row machine where you sit down. Ten reps. This was with a two handed bar.
* Workout 2: 4 sets of about 12-15 reps using about 60 lbs.
* Workouts 3 and 4: Repeat above.

Workouts 1 and 3 were purposely really light and focused on isometrics just to get the rhomboids trained to "activate." Workouts 2 and 4 were more focused on building strength. I progressed rapidly from here. I'm now doing one handed rows with the injured side at 60 lbs x 8 repetitions.

All that said, the pec minor pounding was far more important. You have to loosen before you strengthen. And I would do 5-6 tissue massages per day starting January 16th. And not gentle. Getting on the floor...rolling on my pec minor on a softball...cross friction 30 x 3 times in different locations and then 30 more times along the muscle.

Doing pec minor religiously and then adding in the posterior work, results were noticeable within a week's time.

KY

Thanks for the reply Ky, So no Lower traps activation or strengthening stuff?
Have u resumed to normal gym routine yet?

Hellothere,

Well, a couple of other exercises I've integrated into my routine:

* Prone Cobras -- lay on a swiss gym ball face toward the ground with feet on the ground. Squeeze scapula together and raise straight arms with palms rotating up. This activiates lower traps. I started with no resistance and held this position for 30 seconds. I then moved to 3 lb dumbells and now use 5 lb dumbells.

* External Rotation -- Simple enough. With bands.

I'm not quite back to my regular routine. I've just lost too much strength due to the nerve compression. All of the muscles on the left side of my body -- tricep, bicep, lats, rhomboids, deltoid, etc. -- are all weakened in comparison to my healthy right side. The tricep is the worst offender. It's the reason why I fail at pushups around #10...my left tricep just gives way.

Now that symptoms are gone, I'm increasing intensity. I'm using something called "myo reps" to accelerate strength gains on my left side. So for example, if I was doing a one armed row with my left hand to increase rhomboid strength, instead of doing just one set of 8 reps, I'll do one set of 8 followed by 15 seconds of rest, then a second set of 5, rest again, and then a final third set.

I'm getting there. My goal is to be at full, even strength by April 1.

Knock on wood.

KY

Well good work with your progress! I Am going to begin the beating of the pec minor religiously as i do think that is somewhat contributing to my symptoms. I think i could have this resolved within the next 8 weeks to be realistic, there is just one more element i seem to be missing which is going to take a bit more trial and error to figure out .