My question is how does one differentiate between the three? Or diagnose the difference?

Is it possible to miss ATOS in Doppler Ultrasound? My doctor had me do that, and it says impingement is detected at 50% and above. Thats a pretty big margin.

Also, Dr Collins says TOS is necessarily ATOS/VTOS as they go hand in hand with NTOS (paraphrasing). WUSTL site shows symptoms (numbness, tingling) common to all three.

I have tinnitus in my left ear (left side TOS is more severe) and left side foot is always buzzing/vibrating. Collins website seems to indicate that this is all related and i may be having vascular compression too.

So confusing all this is.

They can all be related, it really depends on the severity of one type over the other sometimes.

Limited blood flow can affect the nerves & muscles.
Nerve impingements can affect the signals sent to the muscles & vascular system.
Kind of a what came first..but they are intertwined most times.

Mainly most of the testing is to make sure there is nothing obvious or anatomical that is causing your TOS symptoms. And to rule out other reasons or other conditions.

If nothing obvious shows on all those tests , depending on the severity of sx & pain, surgery may or may not be the preferred course of action.

Each person has to figure out what will be best for them in the long run.

I have seen Dr. Pearce (NMG @ Chicago) and currently see Dr. Donahue (MGH @ Boston). Both doctors do testing for ATOS differently. Dr. Pearce's test showed 100% occlusion of the subclavian artery, while Dr. Donahue's test showed moderate narrowing of the artery. I was diagnosed with N+ATOS by both Doctors. Per Dr. Donahue, there are a very small number of his patients that are graded with moderate narrowing, with almost none graded severe. Dr. Donahue had agreed to due surgery after the initial test, but recommended PT + botox first.

I have been in PT for ~9 months. I don't know if I can say that I am cured, but I do workout regularly. I'm currently training for a 1/2 marathon with relative success (some aggravation of symptoms around ~7 miles). Also, my workouts are getting close to full body workouts, even integrating the typical problem upper body areas into workouts. I take extra care when working the chest, bicep, and doing shoulder pressing exercises. Stretching is critical for me. To give you an idea of how strong I've gotten in some exercises, I can bend-over-row 75lb dumbbells. Yes, that is one arm, and with good form.

I was very athletic prior to symptoms. I also had debilitating symptoms at onset.

PT definitely is working for me. I am not however, saying that PT works for everybody, as I can only speak for myself. Also, my PT's are the cream of the crop.

That is great, Seeman!!

How did you acquire TOS, if you know?
How long did it take for the worst of your pain & symptoms to improve?

I think this info would be very helpful for future readers..

Awesome PT or DC - whatever the label... is so great when you find one

Seeman, how many times have you got the botox injections? Where are your injections? Do you ever feel like the injections have worn off? How long does it take for you to feel like they have worn off?

Hi Seeman - thanks for your post. Can you share some of the things you're doing in PT?

Jomar-

My TOS was likely caused by a number of factors. As far as pain- Botox was 10/2013 and PT started (again) 11/2013 and is ongoing. Pain levels fluctuated until a few months into PT. I was cleared to start going to the gym in March and pain levels have been pretty good since that time.

A good PT is priceless. If you are in Chicago and need a PT, go to Dynamic Physical Therapy.

Eight- I had botox one time. Injections bilaterally in anterior scalenes and pec minor. I would guess that the injections wore off after a few months. Total relief of symptoms only lasted a few weeks.

Cyclist- I'll answer your question when I'm at home and can reference some exercises.

I would appreciate you sharing the exercise as well.

First, I apologize for not having posted descriptions/pictures of the exercises I do. I tried writing up all the exercises, but was unable to articulate what many of the exercises were, and how to do them. I am headed to PT today and am going to see if my PT is willing to take pictures of all the exercises while I do them. Perhaps I'll be satisfied enough to post them then.

I also wanted to give an update on my progression in PT. If anybody does not know, I have N+ATOS, with the arterial graded as moderate through tests w/ Dr. Donahue in July 2013. I had 100% occlusion of my arteries with arms overhead when originally diagnosed in 2012. I have no idea where my compressions levels are now, or if they even change over time. I go back to see Dr. Donahue in February.

Anyways, back to my progress update- Today will be my 25th straight day going to the gym EVERY DAY. I am alternating workouts of 1.5 and 2.5 hours every other day. I spend roughly 1 hour doing neck & core strengthening/stability (everyday), another hour between cardio and/or weightlifting (every other day), and less than 30 minutes in the sauna/steam room.

Some recently changes and additions to my "do consistently" regimen are-
1) steam room/sauna: excellent for relieving muscle tension, improving circulation, and reducing nerve irritation. I go every day.
2) do not recline in seats: I drive with my seat vertical. If I recline the seat even a few degrees, it will aggravate my nerves
3) regular, short periods of cardio help minimize nerve pain
4) do nerve glides
5) stretch

While I'm still far off from the strength I used to have, I'm progressing fairly well. For people that wonder if you can workout w/ TOS, I dumbbell press 75lb, row 75lb, bicep curl 30lb, lat pull down 50lb, and shoulder press 70lb (all are per arm). It's not close to where I was before diagnosis, but I get feel that I am continually making progress. I still have some nerve pain, but exercise (when done properly) helps.