I just got diagnosed with bilateral arterial thoracic outlet syndrome. I am a baseball player with a history of shoulder injury and surgeries. I would like to avoid surgery if possible. Has anyone heard of Pri or any other methods that work with rehab. I feel like I've done quite a bit of rehab from past injury and surgery. Pulse goes away when I turn head or pinch shoulder blades back.

How did they diagnose? Did you have blood clots? Are you on blood thinners? aTOS is nothing to mess with. I've read people treating it conservatively but that is case by case basis. You would want to be in the best of hands dealing with arterial compression.

We did ultrasound which I don't showed anything but also had sensors to measure pulse. Pulse would be affected with neck movement or whenever I raised my arms in different positions such as pinching my shoulder blades. I don't think I have blood clots and have been thinking about taking aspirin but don't want to mess with not feeling pain when I'm supposed to especially when I train all the time.

Any more info would be appreciated.

I'm no doctor but that doesn't sound very definitive. Definitely could have some minor venous or arterial TOS though. If your arms aren't swelling or changing colors and you haven't gotten a clot it might mean you have caught it early. Compression of veins arteries and nerves can happen at many locations from the neck to the shoulder. Pec minor can be a big culprit as well. I would talk to your PT about loosening the muscles in the neck, (scalenes, SCM, mostly). You want to loosen the muscles in your chest, primarily the pec minor, and you want to strengthen the back muscles, lots of pulling like rows, shoulder retraction with bands, etc. Your pt can help with specifics. It is important to get the muscles to relax before you do a big regime of stretching strengthening. This is the protocol I am doing now.

It seems like you gain an inch and lose and inch but you have to rejoice in small victories. To "cure" TOS it's a change in the way you move, it's a change in the way your body works. I would talk with a throwing coach and see how you can work on your mechanics as well. As you know throwers and people in overhead sports like baseball are at an increased risk for serious issues with TOS. It is the nature of throwing and the violent movement in that area from the neck all the way down the hand. You must be aware of posture 24/7 and keep shoulder blades back and down like you are trying to put them in your back pocket.

Good luck, I'm perusing around. Not a lot of people around here anymore it seems.

By the way if pulse goes away when you pinch shoulder blades back this tells me ( once again I'm not a doctor ) that you have pec minor involvement. Why? Because the pic minor actually inserts into the caracoid process which is actually part of the scapula. When you pull them back it actually is tightening that bit of muscle in the front of your chest like a fish fighting you on a fishing line...

This is why I say have some soft tissue work done on your pec. Dry needling the pec minor has been amazing for me. A lot of people with pec minor syndrome also find that their shoulders are unstable and they have some winging of the scapula. Find an expert PT that is able to help stabilize your shoulder joint but also has techniques to loosen up that pic minor. I might guess you have tight traps too, maybe some pain in the scapula area, difficulty turning neck to the painful side?

Keeping my shoulder blades back and down makes my symptoms worse. I don't think it's my pec minor because I purposefully and consciously monitor my chest when I pinched my shoulder blades and they seem very loose.

I am looking into some thing called PRI where you focus on adjusting your breathing patterns and posture such and curing flared ribs. I am just confused about whether or not I'm supposed to expand my chest or flatten them as it is really hard to internally rotate the ribs while expanding the chest at the same time. Many people say breathe through your belly but I'm not sure if that's 100 percent correct.

How do people know it's just arterial or venous when all three go through the same pathway between first rib and collarbone? Wouldn't all three be affected?

I honestly don't know how they determine that. A doctor would have to run specific tests. Yes they all run through the thoracic outlet and under the pec minor. My guess is that the reason nerves are more commonly affected is that they aren't as deep as the vascular structures are. Arteries tend to be pretty well protected places in our bodies, along with major veins. This is my guess as to why these two causes are more rare. People with serious venous/arterial TOS typically end up in an ER before they know what TOS even is because of severe swelling/color changes.

This isn't to say that someone with nTOS may not have some construction of the vascular structures and it could get worse over time if patterns aren't corrected...