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Thoracic Outlet Syndrome Thoracic Outlet Syndrome/Brachial Plexopathy. In Memory Of DeAnne Marie. |
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07-30-2015, 03:24 PM | #31 | ||
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My biggest problem is I am in a place where TOS familiar PTs are next to impossible to find. The handful of PTs I have met who are empathetic are so overworked its next to impossible to get time with them. Others, can't help.
I am doing everything on my own, basically with the help of folks like you to provide tips. Since serratus is already weak, the problem is that rhomboids are probably already strong and overdominant. Antagonists being strong would further weaken the serratus effect. Also, we want to improve our upward rotators. Rhomboids are downward rotators and adductors if I remember correctly. My other idea is to strengthen the rotator cuff - infraspinatus, supra, teres minor and subscapularis. Guess being that it would take some of the load off the upper trap and levator. My guess is that more upper trap and levator get overworked worse it is is for us, since they drag on the delicate cervical spine and irritate the structures all of which seem to have nerve endings. On the other hand, I wonder if strenghtening the upper trap is required if the serratus continues to misfire and is weak. One thing I have learnt (and I KEEP FORGETTING) is that i shouldnt read/sleep with my head propped up on a pillow, moment i do so my hands start burning up. I wonder whether that is because scalenes activate causing scapular instability or because the neck flexes forward too hard because deep flexors are weak compressing the cervical roots themselves. I also have a disc bulge at C6-C7 but doctors tell me that is not the issue. |
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07-30-2015, 03:30 PM | #32 | ||
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That's how I am navigating. I wonder though if we are not approaching this from the ground up, whereas we should be looking from the top down, ie the cervical area. The scalenes and the c-spine need to be switched off/fixed for the nerves downstream to do what they are meant to. |
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07-30-2015, 03:33 PM | #33 | ||
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Regarding doctors /medical professionals. Met all sorts. Including one quack who told me my symptoms were all in the head, was insulting and then said "TOS heals in a few months, nobody has it for more than 2 months". I kid you not. The quack is down the road from me and I have learned to be very polite and mostly keep my irritation in check. However, I finally snapped and told him he didn;t have a clue of what he was speaking and got up and left, as I was leaving he started panicking & told me I was obviously well read, bla bla and he did want to help bla bla. One thing I have realized, even the medical field has no shortage of buffoons and on top of it, many get arrogant. Some want to help but don't have enough knowledge or are out of date. Some are too busy to give you the time that is required. Some are just money minded. The knowledgeable practitioner who is in the field to help people is so overworked he can barely manage the time to see us. |
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07-31-2015, 06:47 AM | #34 | |||
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Sorry for the delay in reply. I've been down with the demon arm again. I try not to post when I'm in so much pain or wallowing in crapulence, it's not productive for anyone, hahaha.
So first, the biznatch end- Akash- horray!!! Some relief!! And sweet corn casserole! Ya know, positive doctor TOS stories are fun days at the DMV. How can Al Roker poses a new mortal body with litter repercussions, and people who want to hold their heads upright lift their arms, and consistently take deep breaths are wasting valuable medical time? It's not like this has been an identified condition before even anesthesia and hand washing were trendy or anything.. ... If you cannot tell by my references I don't have tv or get out much anymore Interestingly, none of my current docs will admit to this, and I don't have any document to verify she wasn't messing with me, bit a previous ortho once told me that the 90 maneuver , a typical diagnostic for anterior scalene compression, is sometimes relieving for middle and posterior, Scalenes , long as the elbows don't go over the shoulders.. Just interesting.. Anyhoo! I'm culling the data collection now. Please let me know if you have any interest or preference in research, as I have a hit of a collection after having to self advocate for so long. It will take a bit for be get back to chair pose to send them out to you guy, but they not forgotten! I have a science background as well and deal mostly in academic publications, but I can find you some other stuff as well if you prefer. Also if you like can send you some links to some medial scalene self relief techniques that have been very effective for me. There can be a very fine balance in the neck massage, although I hope you're nerves are not at this point. Sometimes it seems like once you find something that finally works and brigs relief it Turns on you after a few days!! Augh!! There is a science behind this tho. Basically your nerve cells have something called an action potential, which is the ability of the nerves to get exited and send an impulse from one end to another. When a nerve is irritated (but not fully compressed or cut off, measurable on a emg a Lowered through No velocity) its action potential goes up so to speak. It takes Less stimuli to activate the nerve impulse. Whether it be cramp, or 'sleep' or twitch, or general freak out, it really takes very little to set it off. This is why muscle hyper trophy, scar tissue, fibrous bands, posture, surgical slings, and that goddam 1st rib cause so many issues in the Grand Central Station that is the brachial plexus. And, for better or for worse, our brains are Very adaptive to certain stimuli, much like you don't feel the constant sensation of wearing your clothes. Our brains however are hard wired Not to shut off that blinking"problem" light. So what what suddenly distracts one day fails the next. Less becomes more. Long winded, but I hope this helps you understand your tricky neck more. And Yes! Compensation could be a huge issue! And yes! Strengthening your deep cervical flexors Could possibly take pressure off your Scalenes! This is a big favor is ergonomics and, posture adjustment, occupational therapy, all that jazz. The compensation likely extends past your neck, into your shoulders, mid back, hips, and even feet depending on on how long it's been. (Compensation for chronic creepy shoulder would up tilting my hips waaay to my right. Pt for that Didn't fix my shoulder or tos, but solved the killer migraines). Scalenes are meant to be stabilizing muscles, for jostling rocking, leaning, etc. They're your struts, but injuries and postures easily put them in control, and they are Full of nerves. If you're already out of whack, than getting your neck back in to shape is something possibly best supervised. I've learned hard what feels "right" after a while is really screwy and it's good to have someone supervising. Also, someone stopping you in those dark "I just want my head back" moments where you try to do All the exercises ever.. It is Amazingly hard to find a TOS pt. All of the people I have contacted in my long, drawn out saga promised to specialize in it but turned out to be utterly clueless upon signing the paperwork with them. There is the sticky post on here with the suggested PTs, but it is a little dated and a kind of insurance selective as I've found. My current PT(#5) like yours, is totally baffled by the whole brachial plexus, tos, why you make faces when you lift your arms thing,, and suggested I contact my PCP about getting a second PT referral for someone certified through the postural institute http://www.npionline.org People trolling the PT thread probably have some suggestions as well. Also consider taking to a pain doc, physiatrist, etc about your continuing whiplash symptoms. This is a definite start point, and dx, which gives you a Lot more to work with than most! Those Scalenes can be shut off with medication such a gabapentin (ugh), Lyrica, topamex, or more than likely a trial injection of numbing agent followed by some Botox to shut the bad boy Down. |
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"Thanks for this!" says: | Akash (08-01-2015) |
08-01-2015, 01:02 PM | #35 | ||
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SOD, that makes two of us. I rarely if ever step out now for personal stuff. I didn't get all your references but I can google them up I guess.
I am based out of India where PT itself is a developing field and ortho docs decide everything and many as such don't develop diagnostics capability. Thank you for your details. Do please send any references across - I am reading anything and everything and what you have is clearly sensible stuff. 1. I think I have some form of dystonia going on. On the left side, my deep cervical stabilizers are torn up, on the right side of the neck, weak. Scalenes overactive on both sides, right much more so. That spasm on both sides shut off LTN on right (causing TOS via scapular instability and not just scalene spasm). On left, it caused TOS via weak serratus and not completely switched off and general scapular instability + brachial nerve compression. Blue hands and not just clawed ones mean vein compression either between clavicle and rib or Anterior scalene and SCm Apparently, weakness on one side of neck makes other side flare up in hyper facilitation per weblinks to compensate. 2. My symptoms worsen when I flex my neck and my arms, upper traps all burn up when i flex my head down. I am wondering whether I have positional stenosis thanks to cervical cord compression as my disc bulge at C6-C7 acts up in flexion. MRI required but again, neck fusion surgery seems to be the answer and will only partly address my issues and not the scalenes. I am wondering whether this is the reason my upper traps spasm and not just the levator/rhomboid overwork due to a weak serratus. My current method - I think - is to somehow activate my deep neck muscles and keep them up to switch off scalenes. Problem is neck flexion activates scalenes. I tried the Mc Kenzie neck retraction method, and oh boy, it helped my posterior neck symptoms but overactivated my front muscles, which coincidentally included those blasted scalenes and SCMs. I did a lot of exercises to activate my serratus, and sometimes it works. But as long as the scalenes keep spasming, its a mugs game. |
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"Thanks for this!" says: | jzp119 (08-01-2015) |
08-01-2015, 01:06 PM | #36 | ||
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Please do send the medial scalene relief exercises or stretches. Thank you!!
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08-04-2015, 01:23 AM | #37 | |||
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Cripes!! I don't know why I keep writing novels as responses, it has apparently become compulsive, haha! Strangely therapeutic, and allows me to stretch my cramped nerd muscles. I hope these are helpful are at least entertaining.
Sorry for the continued delay on the medical texts. I have them bookmarked on my laptop, and a keyboard in a physical trail I can't even imagine taking on these past few days. Akash- reread again at a more reasonable time of day, a little less exhausted, hahaha. If you try out the posture work Def do it under the guidance of a pt especially if you have a cervical bulge, one better informed than your last batch. Although based out of India,I don't know which direction to send you in! I will trawl the net and see what I can find! I'm really stunned that your disk bulge is being passed off as a non issue. What?! Docs keep telling me my symptoms don't make sense/ they can't do anything Because I don't have a disk bulge! That's like.. Classic reason to have these kind of issues! Time for a second opinion. Yeesh Jzp119- which actually brings me to your MRI thing. It's not that unusual and seems to be a pretty common story on here and with TOS. A lot of TOS diagnostic winds up being a process of elimination of more common pathologies, the top of the list being cervical radiculopathy and disk bulges. (Maybe more truthfully at the top of the list right under complaining too much and psychosomatic) Even the 'official' TOS/brachial plexus injury diagnostics are highly subjective in not only how they're preformed, but interpreted. This is especially true when the symptoms are largely neurogenic. Can't just take a swab and send it in to the lab. A fancy brachial plexus imaging may have its place in your future, which push for an MRN which is going to look more at your nerve paths than soft tissue, but honestly unless the test shows a some Massive friggin train wreck of a result most docs don't seem to know what to do with this info. I wound up pressuring a doctor into ordering an MRN for me because my symptoms were so Insane and no one seemed to have a guess and to what my next move should be. The results came up with nothing major, but noted irritation and issues along my C7, C8, and T1 root nerves (omg lower brachial plexus nerves controlling my arm scapula and serratus, wtfnoway!) They looked confused and affirmed that maybe there was a brachial plexus injury but they didn't know what to do.. Ugh! Sorry, tanget. Point is, don't stress about more tests yet. Focus on finding help with symptom management. Finding out the "why" isn't necessarily the key to getting your life back and you may never have a satisfying answer of wtf is wrong with your should-scapul-neck. With your pain level still manageable I would even stretch to say avoid allowing docs try and pass you off on the dead end of increasingly ridiculous tests, yet. At some point it become synonymous with "I don't know, go away". I know it seems like you've already tried a lot of things, but there's many different avenues of conservative treatments you could pursue. Injections, nerve meds, pain docs, etc. In the end medicine is still a Practice. Much like not every musician can make a song you like, not every doc has what it takes to deal with you. You've got a really solid chance a being taken seriously because of your history or trauma, and surgery. And although the pain is smearing Awful on every aspect of your life hasn't reached the everything is on fire point. It's harder to come back from burning wreckage. Consider your scheduling wait times in relative comparison to THIS. FOREVER. Makes 10-14 months seem like a burp. (Ps- 10-14 months?! Call someone else, they are trying to dissuade you from scheduling. ) pro tip- try to line up a couple at the same time, call and bother them every week and check for cancelations. Sometimes really works out time wise, and then you have a plan B when plan A turns out to be mystified by why your scapula levitates. And damn, good call. Yea, my friend had a sudden onset blood clot style TOS from his body building and successful surgery. His neurogenic symptoms were minimal, but it didn't really go on long enough for him to explore the wide world of crap arm. He arm turned purple, hard surgery, bounced back fast. Still. Remember, this surgery is a last resort. It wouldn't be suggested at All for anyone without a fairly significant success rate. No, not All surgeries work, but not All of these cases are caused by rib compression. Like I've word spewed, there's A Lot to this tiny space! A Lot that contributes to these issues. If your continuing symptoms Are caused largely by cervical or 1st rib compression, or associated scar tissue, anterior scalene compression, and lower brachial plexus fibrous bands, there is documented between a 50-80% success rate of full recovery after surgery. That's some damn good odds that look even better compared to the odds of laying on the floor in pain every day based on the last few years. As in 1/1, as in That, my friend, is the death sentence. If people can compete in the Olympic on metal spatulas for feet you can climb again as long as you can stop Hurting for a while. And yea, some doctors truly DNGAF, or think you're lying, or a hysterical woman (maybe not in your case) but it's not the norm. Most just dunno. The complexity and subjectivity, as well as desire Not to be wrong and avoid liability pushes a lot of them when dealing with TOS brachial scapular weirdness to the realm of shrugging and making you someone else's problem rather than taking the responsibility of making the call themselves. It's the same reasoning behind the miraculous ability to help people much less healthy than yourself. Think of it this way.. If you go to the mechanic and tell them your car is shaking like crazy, the steering is out of control and pulling all over the road, and it makes a terrible noise while driving.. That could really describe any number of things very clearly. If the mechanic takes a look at your car and you have a flat tire (ie- smoking, age, obesity, sedentary lifestyle, bad posture) the issue is probably the tire! Its smarter to try fixing that before ripping apart the transmission or the cv joints, and you'd be pretty cheesed if they did amassive overhaul first when you could have just swapped it for a spare in your driveway. So if you brought your car in, mechanic said change your tire, again, which you Know is fine.. You'd go another mechanic, wouldn't you? And I'm totally with you, squishy chairs, beds, pillows, or curved back chairs are Death!! I have a hard mattress which has kept me ok. Canvas military cots are also the best things ever. |
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"Thanks for this!" says: | jzp119 (08-05-2015) |
08-04-2015, 06:03 AM | #38 | ||
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Hey jzp119
We could be in a similar situation, however it's been 10 years I've been trying to fix this and finally now I'm gonna go all out to fix it. It may require me traveling to US from Australia as there doesn't seem to be a lot of experts here at all. What set me off to get serious about this was reading about Baseball pitcher Chris Young and how he made a complete recovery from similar symptoms to mine. Link; tos.wustl.edu/en/Patient-Features/Chris-Youngs-Story My case; - 33 year old male - Football, surfing and martial arts non-stop growing up - Around 22 I hurt my shoulder lifting weights - Diagnosed with torn rotator cuff (supraspinatus) - Never really healed despite $$$ spent on PT etc. - PT had me doing painful neck stretching causing pins and needles (This may be the source of my problem) - Realized my scapular is winging and my shoulder is a few inches higher - Winging seems to be Dorsal Scapular Nerve related (Rhomboids/Lev Scap) as my serratus seems ok and the winging itself is subtle - EMG says everything normal except 'Borderline changes in Rhomboid/Levator Scap.' - MRI etc. no problems found - Neurologist baffled and wants to show me to his colleagues - All up I've prob seen 20 doctors and PTs - Kept training in the gym fpr last few years with progress being 3 steps forward 2 steps back. i.e. Make progress one week>symptoms flare up>I lose strength>start again>repeat - Symptoms are; Dull ache, heavy arm, pins and needles in fingers, shoulder clicking, shoulder arm weakness - I always get this burning in neck area and a strange burning/pulling feeling in my trap/neck when I sit at a computer Had some frustrating days but I'm pretty confident I'll get it fixed. Basically now I'm ready to do whatever it takes to get it fixed, will pay anything to go overseas and get the surgery. Will try here first but it's not looking good so far. I will keep you/this thread updated, hopefully you can do the same. This pic of a model illustrates one of my main problems, I have built my trap muscles up significantly but on the injured side there is a chunk missing (the bit up near the neck that runs at an angle). Possibly levator scapula. Can someone post this I don't have enough posts i.imgur(dot)com/JHV5wsH.jpg |
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08-04-2015, 09:02 AM | #39 | ||
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This is what I just discovered my pain area is: http://www.physio-pedia.com/File:Self_Exercise.png Supraspinatus pain. It just won't go away. And my symptoms to a T: - I always get this burning in neck area and a strange burning/pulling feeling in my trap/neck when I sit at a computer And: - Symptoms are; Dull ache, heavy arm, pins and needles in fingers, shoulder clicking, shoulder arm weakness I think I injured my Supraspinatus or the nerve itself when I fell with my arm outstretched. Can you tell me some of the PT you did? Before you move to the US, I'd suggest you seek out Lynn Watson, she is a PT with TOS experience from Australia with several papers to her credit. |
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08-04-2015, 09:51 AM | #40 | ||
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Cant a rotator cuff surgery fix your issues -the pain at least?
Here is the pic you wished to reference: http:// i.imgur.com/JHV5wsH.jpg |
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