[Hiker]

Hi all!

I don't know if I have TOS, but I suspect I do based on the symptoms.
Was suspecting it for some time now and recently my PT suggested that I might have it.

My symptoms are headaches (15 years), neck pain (3 years), bilateral shoulder
pain (1 year), numbness in fingers and forearms.
Shoulder pain is really disabling and increases when I move my arms or start typing. I have been in pain every day for the past 9 months which is gradually getting worse.
Doing anything with my arms like cooking, driving, reaching overhead etc
flares up my symptoms and brings up severe delayed onset pain which lasts a couple of days.

Another symptoms I have are a weak pulse in my wrists which disappears when I bring my shoulders back and feeling of tightness in my armpits.

I am and engineer and have been working on the computer for 10 hrs/day for 20 years now which probably explains all this.
I the past year I tried to reduce my stress level and work hours significantly, but this made no difference. Took 2 months off of work, but keep getting worse.
Now I reached the point where I cannot continue working due to constant pain.

The doctors say either "nothing wrong" or "muscle strain".
Been to four different doctors and three different PTs.
Did X-Rays, CT, MRI of the neck and brachial plexus, EMG, NCS, countless blood tests.
The only definitive finding is a fracture of the first rib.
There was no trauma which could cause this so I am assuming it is a stress fracture. I wonder if this could be related to my symptoms.

I have been going to PT for 2 months now, but see no improvement and, in fact, am not even able to do any exercises they are giving me without triggering pain.
This is a bummer as I used to exercise daily, run regularly and was in good physical shape until this year.

Does this sound like TOS to you?

[Jomar]

It sounds very much like what I experienced, not enough for general MDs to give a clear cut dx of TOS , but definitely related to a long term chronic RSI w/ neck & upperback involvement.

I was 15 yrs @ assembly work, it took me 2.5 to get back to 75% - I did have to deal with work comp delays , or I probably would have found better help sooner.
Actually a very good chiropractor I found 1.5 yrs into it was my best help, then a PT teacher was very helpful by doing the top rib mobilization for me..
I was off work most of that time. or on very modified use..
IMO trying to work a demanding job and trying to recover does not work out well, what is most important , your health or the job?

I suggest finding some highly skilled PT /DC and learning as much as you can about body/posture/myofascial pain syndrome.

I think if you can address all those and stay with it you will see improvements long term..

I still use my far infrared heating pad often & my IF stim for flares as needed, often it is a long term thing to continue with even after the worse is resolved..

some things to do at home & other info-
http://neurotalk.psychcentral.com/album.php?albumid=422

How knowledgeable does the PT person seem to be?
Triggerpoint info - if you have TrPs they must be resolved first - before any stretching /strengthening will really help.
http://neurotalk.psychcentral.com/thread125577.html

useful sticky - post # 1 is a crash course of info links
http://neurotalk.psychcentral.com/thread84.html

[Hiker]

Than you very much Jo*mar.
I am still not sure if I have TOS or a different kind of RSI.

I am currently looking for some expert help because the doctor and PT I am working with are not (even though they are trying to help).

Regarding trigger points, I spent the last two months chasing them and I think didn't really find any. But again I may be looking in the wrong places...

[Jomar]

Sometimes TOS is just a label, the possible fixes & helps might be the same..unless you get to the surgical level..

I call mine TOS/RSI/myofascial pain..

[Hiker]

Just came back from PT.
The PT lady said she does not know how to help me
Well, at least she is honest to admit this.

So I am looking for a new PT who really has experience (started a new thread).

[Jomar]

It is good they were honest vs stringing you along...

Many will just focus on the "standard" or "cookie cutter" pt protocol with strengthening too soon - and many w/TOS / chronic RSI just get worse with that kind of tx..

Hope you can find a really good "healer" type provider.

[Hiker]

Yes, the cookie-cutter approach is the problem.
This is the third PT I tried. The first two simply gave me sheets with strengthening exercises which I was doing for months (while I still could). Saw no results.
Now I cannot even do them.

[Jomar]

I suggest searching for PT & DC websites that have some detailed information on them, then make some calls or email with more questions.
ask about any advanced training , client focused treatment vs generic tx...multi focused modalities..

If they have more letters after their name they should have more training..

[Hiker]

Back from the dr. Asked him whether I have TOS. He said "I don't know, it is difficult to diagnose. Go see someone else".

Any doctor recommendations in the bay area?
I know there is Jason Lee at Stanford.
Are the other good doctors who can make a definitive dx.?

[Jomar]

[The only definitive finding is a fracture of the first rib.]

Could they tell if the fracture was fresh or long ago healed?
Did it seem deformed compared to the other side?
Are you sx worse on that side- that could tell if it might be a factor or not..

Generally is your head or shoulders forward of the body when viewed from side by someone? Same for rolled or hunched shoulders..
If so, that posture will crowd the space we need to avoid TOS , so it can be a big factor.

Any past whiplash, sports injuries , head/shoulder hits /falls etc?
some info - http://www.upcspine.com/self.htm