Hello. I just came across this forum, and this is my first posting. I am very interested to read all the discussion about symptoms of TOS. I think I have caused some injury to the brachial plexus nerve in my right shoulder, and I'm a little scared, looking for some words of advice and/or encouragement from others with more experience. While I cant be absolutely certain, I do believe that this is --not-- caused by TOS in my case. But the symptoms seem so close, and I thought the experience of so many others on this forum might really be helpful to figure out how to best proceed.

Several months ago I fell while waterskiing, and when I hit the water my arm was hyperabducted rather forcefully. I had immediate pain behind my right pectoralis muscles, running up into the armpit. I also had tingling sensations in my thumb, and first two fingers (median nerve). The symptoms lasted several weeks. There was no swelling or bruising. The tingling was at its worst with external rotation of my shoulder, but seemed to resolve within several weeks. I thought I had recovered reasonably well. But recently, I began to have return of significant pain in the region behind the pectoralis major, around the side just a bit, and up toward the armpit. It's sharp pain, and hurts even to push down on the soap dispenser in the shower (in other words I don't have to push very hard at all to get pain). And I'm now getting a disturbing "funny bone" feeling down my arm and in my hand for no other apparent reason. The median nerve area of the hand and palm is what seems to be affected. I'm almost certain the pectoralis major is fine. And the circulation to my arm is fine. The pain is much more consistent with location of the pectoralis minors, and activities that aggravate my pain seem to be those that enlist the use of those muscles. My shoulder blade and shoulder function seem completely normal and pain free. I imagine there may be some tearing of the pec minor muscle, plus inflammation or scar tissue near the upper insertion that is compressing the brachial plexus causing the nerve symptoms that I feel in my hand. This is my best guess based on research and looking at the anatomy. Does my self diagnosis sound reasonable? I have complete motor function, no numbness, only pins and needles in my hand that come and go apparently at random, causing anxiety. I've also ruled out carpel tunnel, more or less.

I am a little frightened about this. Does anybody have experience with an injury of this type? What are some likely options for treatment? I have just started down the road of diagnostic testing. Are there any particular diagnostics I should be requesting? As usual I fear the worst. I could really use some words of advice and/or encouragement. I am scheduling all the various doctors of course, but in the mean time I hope this forum may offer some help or maybe just comforting advice. Thanks in advance for your comments!

Hi and welcome,
I'm kind of the one that suggests chiropractic usually {an excellent and expert one of course} and in your case I think a very good one should be of great help. Especially one that uses other modalities along with any necessary adjustments.

In a fall situation like that at how many MPH or knots LOL you had to have hit pretty hard - most likely the head/neck and pecs all got some trauma - possibly even the upperback muscles and ribcage.

I'll add some chiro links and you can read more about it.
well more than just chiro links after all -the others might be of help too-
Postural work/info
http://www.somaticsplus.com/ws2.html
http://www.om-rehab.com/treatments.htm
http://www.sportsinjurybulletin.com/...acic-spine.htm
http://www.body-awareness.com/index.htm

Chiropractic care info- a good one can help with many symptoms:
http://www.upcspine.com/self.htm
http://www.uppercervical.org/subpag...b/about_faq.php
http://www.spineuniverse.com/index.html
http://www.coloradochiropractic.org/.../glossary.html

Anatomy links
http://www.getbodysmart.com/index.htm
http://www.gwc.maricopa.edu/home_pag...rial_Small.htm
http://www.gwc.maricopa.edu/class/bi...cle/mustut.htm
http://www.meddean.luc.edu/lumen/Med...em/learnit.htm
http://mywebpages.comcast.net/wnor/homepage.htm
http://catalog.nucleusinc.com/genera...=&TL =512&A=2
http://www.ptcentral.com/muscles/
http://www.realbodywork.com/
http://www.fleshandbones.com/readingroom/pdf/1097.pdf

ART-active release technique
http://www.google.com/search?client=...=Google+Search


Electrotherapy
http://www.vitality-web.com/backstor...Stimulator.htm
http://www.medi-stim.com/overview.htm
http://www.rehabpub.com/features/82004/3.asp
http://www.spine-health.com/topics/c...ctro/el01.html
http://www.skylarkdevice.com/web-site/ele_thera.htm
http://www.bmls.com/electrodes/epc.php
http://rehabilicare.com/protocol.html

Laser/ Infrared/ far infrared
http://laser.nu/
http://www.purehealthsystems.com/infrared.html
http://www.purehealthsystems.com/mus...in-relief.html
http://www.toolsforwellness.com/far-infrared.html

I do want to add that an advanced PT person or even a few docs can do some minor adjustments or our RLNP did mild ones on my daughter.
But you hav eto look around and ask questions

Wow, thank you for this wealth of information! It should give me a little reading to do...

hi, so sorry to meet like this! but glad you've found us. boy, i have to agree with you on one thing, at least. i don't think you have TOS... yet. but your injury is NOTHING to fool around with. this doesn't sound like a torn muscle to me from the sx you are describing i would guess more along the lines of a nerve root injury, i am sorry to say.

you are near mass general hospital, correct? so i would think you have access to some amazing docs in your neck of the woods. that being said, if it were me and i knew at (what i can only guess is) your age what i know now, i would probably seek the consult of dr. david kline (www.chinup.org/news/news1.asp) ASAP if there were any way in hell i could afford to do so. or at the very least, call his office and ask him to recommend the VERY BEST neuro at harvard for you to see for this.

obviously, you are a very intelligent fellow. but i would not lose any more time trying to dx yourself. as i am sure you know from what you have gleaned so far, this is a highly complex area of the human body. not to mention, an extremely controversial area in medicine when you start bandying about terms like "TOS." use 'brachial plexus injury' - might go down much easier, my good man! you need immediate tx, possibly surgery to correct something like this. and i DO NOT SAY THIS LIGHTLY. this is serious. i know this is not what you want to hear. i am so sorry this is happening to you but i do believe your chances for recovery are good if you act quickly to seek the proper tx.

i'm almost reluctant to give you this next site. but because it may lead you to some good practitioners in your area, and i assume you are a grown-up and able to make healthy decisions here ya go: www.rsi.deas.harvard.edu. keep this in mind for when you need to find a good PT or bodyworker... maybe also they can help lead you to a neuro, PM doc, physiatrist, or even a surgeon. who knows.

as far as the diagnostic testing goes, get the consult squared away with the BEST surgeon you can find first. let the surgeon run the show (s/he will, anyway). don't waste a lot of time or money on tests now which your surgeon won't even look at, is my point. by the way, if you don't need surgery, GREAT! let a surgeon tell you that, though. you still need a consult. that is all i am saying here. because from what you are telling us, you could have yanked part of the neurovascular bundle out by its roots and i don't wonder you are afraid. you will feel much better knowing than not knowing, in my experience. knowledge is power. you cannot afford to fool around with this. this type of injury DOES NOT HEAL on its own.

we have a few posters from MA. i can think of 2 off the top: finz and dolfinz (yeah, i know. don't know what's up with the flipper theme, couldn't tell ya what the deal is there...). so hopefully one of them will see your thread; if not shoot them a PM and ask specifically for a TOS-savvy dr. referral, or 3 or 4. save your **** a lot of heartache that way. doesn't matter that TOS may not be your cross to bear, if the doc knows TOS they can handle a BP injury like yours. it all goes together. sadly.

the links our lovely jo55 gave you i believe are from the stickys up top. more where they came from. you can also subscribe to the journal of brachial plexus and peripheral nerve injury through biomed central at www.JBPPNI.com for free which you might find helpful. another one is the 'sorehand list' via www.ucsf.edu - just enter the word "sorehand" in the search bar and you should be able to find it that way. access to the archives on either one might lead you to some very specific stuff you could call up re your particular sx...

the search and advanced search functions on this forum, located in the upper righthand portion of your screen, will help you find more than you ever wanted to know about TOS and any one of us bums, er i mean incredibly helpful folks hanging out on this board...

good luck to you and if you find that you do have more questions as you read through some of the medical literature please feel free to ask. just keep in mind that you are in danger of getting responses if you post here - we are not docs, but we ARE experts on TOS, from the inside out!!! albeit unwilling onez...



alison
"Be Brave"

AnthonyWelcome. You will find some of the best information from the people who have already posted on your thread and others who will follow. I do not have medical info to supply just moral support. I will never profess what you should do but have great confidence in the people on this site who give you very informative information. I feel as if they are family and you will be considered as one also. Good luck. Linda

I want to sincerely thank you all for helping with my question. This forum is clearly very active and most impressive. I never imagined that an innocent water ski day would make me a member of a such a club as this, but I'm overjoyed to know there are people out there like yourselves so willing to help. Hopefully I will get through this awful experience, and maybe lend a helping hand to somebody else one day in return.

So Sea Pines 50, your posting is comprehensive and much appreciated. (But you sure do know how to give a guy a first degree panic attack ) Perhaps some more precise detail about the injury and sequence of events would be interesting, and also help to see my situation more clearly. (so here goes, sorry for a long winded posting...)

I actually got this injury one year ago, aug 13th, last summer. The injury was to my right arm and happened just as I said in my original posting. The following morning I spoke by phone to a shoulder surgeon about this. His advice: give it a week or two and see if it resolves. Probably stretched the BP, and a few muscles as well. So I followed this advice, and in about 4wks I was nearly symptom free. I did have a minor flair up of muscle pain after throwing some bread to the ducks, but no nerve symptoms.

Then I went a full seven months symptom free. I figured this scare was behind me. Then I got rotator cuff repair on the left shoulder, by the surgeon I previously mentioned (did quite well with that). So the right was now my dominant arm for at least two months while left was in a sling. This must have aggravated whatever situation I have going on in there. The muscle pain came back fairly sharp, still no nerve symptoms. I gave it the usual 4-6wks to heal and it did. But then at about 8wks I pushed myself up from my chair using my arms and got the nerve twinge in the first three fingers and thumb. It was the same feeling I had at the time of the waterski fall.

So it has now been 3wks since the return of these nerve symptoms. They seem to come and go, and it feels as if I have a little knot inside my right armpit, causing nerve symptoms down my arm into the median part my hand. But there are no knots or abnormalities that I can feel to the touch, it's just the sensation I have. This sensation of a little knot and the pins/needles of course causes me to have a very large knot inside my stomach -- it causes me great anxiety with which I am now struggling (and suffering might add).

Here is what I've done so far. Saw an ortho PA at top rated New England Baptist Hospital (NEBH). He ordered shoulder MRI which we reviewed to find nothing abnormal. He referred me to a good shoulder surgeon at NEBH (but not the same guy that did my cuff repair). He said shoulder MRI was not the correct study, that a BP MRI should have been ordered instead. So he did a full shoulder exam and said I may have injured BP, that it could take 1-2yrs to fully heal. Otherwise shoulder seems fine, and pec major/minor are not torn. He referred me to physiatrist that I will see this friday for EMG, and to decide if BP MRI should be ordered. My sense is that this surgeon is extremely competent, but maybe not so well versed in TOS/BP issues (?)

Also saw my general practice doctor who gave me the following advice: (1) continue on the present course with NEBH and demand BP MRI (2) try not to worry too much about this because if symtoms resolved completely for seven months then nerve is likely in very good condition. Probably inflammation or scar tissue secondary to muscle injury causing nerve irritation or compression. (I don't know how much credibility to put into this advice, but he is quite a good doctor in my past experience), and (3) consider SSRI based on fact that I've had such a string of injuries and difficulties in the last 1-2yrs that it has put me in a not so healthy frame of mind.

I looked up Dr David Kline, and found he has excellent experience, but is in Louisiana (I'm in Boston). But could not find a phone contact for his office. On the one hand he seems to be exactly the type of doc I'd like to have overseeing this, but on the other hand I don't want to create chaos by contacting many doctors in parallel. But I do want to get connected with one lead specialist that knows about TOS/BP that can run the show effectively.

Maybe I should find a neuro doctor specializing with BP and peripheral nerve injury. If anybody has contact info for Dr Kline I'd be really appreciative. Or to other good TOS/BP specialists in the Boston area: MGH, BIDH, NEBH. Any other comments or feedback based on the above additional information, also greatly appreciated. Many many thanks!

sorry about the panic attack, have you been talking to my kid? []

i'm on the left coast so i can't really help you out with local referrals. wish i could. that's why i suggest you PM finz or dolfinz, or go to one of the support meetings at that RSI group on the harvard campus - you'll get lots of ideas that way, i'm sure.

my best suggestion would be to find a PM doc with a background in neurology to run the show (order diagnostic tests, refer you to surgeons and other specialists, prescribe meds, etc.) definitely look for one who knows TOS and other peripheral nerve entrapment and injury disorders. specializes in that area. that, my friend, would be golden! and i think your internist's idea about an SSRI is not a bad one; actually you may be interested to know that PM docs have found that some of the meds in this class are helpful in treating chronic pain and are prescribed off-label for that purpose and not just, per se, for depression as such. my PM doc actually gives me Namenda (which targets the NMDA receptors in the brain), which is an alzheimer's med. he was hoping it would help the nerve pain... but i find it actually addresses my depression much better than any SSRI i have ever been given (unfortunately, it didn't do squat for my nerve pain and i still take topomax for that - but everybody reacts differently to each med and you just have to keep trying various ones until you find the right chemical soup).

i know dr. kline is in LA; he's a good old boy! renowned the world over - he's the guy who saved al gore's kid. dr. charles brantigan, one of the 3 top TOS surgeons operating out of denver, CO, studied under dr. kline. i believe he can be reached at: 504.568.6120 / 504.568.6127 (fax) / dkline@lsuhsc.edu. hopefully, that contact information is current. there are several mailing addresses for him and if you punch his name in the search bar on this forum a bunch of stuff will pop up. and we actually had one of his patients on here not too far back; perhaps you could PM her if all else fails...

question for you: what kind of a surgeon is it that you are consulting with at NEBH? because with all due respect, if it is another orthopedist, i would not really pursue this avenue any further right now. you don't appear to have an orthopedic problem, so you need either a neurosurgeon or a vascular surgeon. top docs. take it from someone who wasted decades getting misdiagnosed by orthopedic surgeons when what they really had was a severe neurovascular entrapment disorder (i have a rare form of TOS)... these guys, for all their knowledge and experience, can unwittingly lead you down the garden path. the bald-faced arrogance can get in the way - shall we say, BIGTIME!%$!%$%!#%!#! not to mention the ignorance and controversy in the medical profession about this area of the human anatomy. it is truly frightening.

this is very tricky stuff. what feels to the patient like muscle pain is really nerve pain. and vice versa. and don't forget the vascular components - they are in there, too, and can be deadly serious. (breathe, man, breathe!) i'm not trying to scare ya and i'm only here to help. trying to cut through the BS and save you a whole lot of heartache. i made myself a promise a long time ago, that if i can help anybody else to avoid going through what i had to go through to get to some real answers and the right tx, then i would do it. so that's what i'm about.

the EMG, and i assume they will run an NCV along with it, that you're going to have on friday, could reveal some information about what is going on, but only if the right TECHNOLOGY is being used. and it also depends on the person running the test and reading the results. dr. scott fried's site will give you a lot of info about evoked potential, SSEP, etc.: www.nervepain.com; he is down in PA (a very good TOS doc, by the way - well worth the trip if you can swing it). dimarie knows a lot about this subject and posts frequently about it. you could post to her or shoot her a PM; she is very responsive and has a heart as big as the world.

a plain old MRI of the BP won't show much, unless you have pancoast's tumor, i'm afraid, or something like that. my understanding, anyway, is that a more useful test would be a 3-D MRI/MRA of the BP, but again, you would need that to be done and read by someone who knows what the heck they are doing. i'm at a disadvantage here because i don't know the boston area. see www.tosmri.com, it will show you what i'm referring to here i think.

physiatrists are good to have on your tx team (and it does take a team, with an injury like this), provided they know their stuff. but what would be GREAT would be if you could hook up with a TOS-savvy PT to start going to 2 - 3x a week. if what you are dealing with really is only nerve entrapment (which we hope it is! maybe your muscles are just clamping down to protect irritated or compressed nerves in the middle trunk and you won't have to have a BP release after all - that would be AWESOME!!!), then a PT - maybe in conjunction with an excellent bodyworker (feldenkrais, alexander, muscle activation technique practitioner - hellerworker, bowenworker - there are lots of similar postural programs out there...) might be able to design and develop the right program for you to calm those sx down and get you back on the road to recovery without an invasive procedure like surgery.

another pretty standard test to see if you are a good candidate for a BP release surgery or not would be a scalene block. or perhaps in your case a pec minor block would be indicated (for a different type of surgery involving that neuromuscular group); i really cannot say. but those are definitely ones i would let the surgeon order up for you at the facility of his or her choice (some surgeons prefer to do the procedures themselves).

trigger point injections, botox injections, stuff like that are other options you could certainly discuss with your PM doc before making a big decision like surgery. your body wants to heal. that is the good news. so anything you can do to give it the right signals and to put it back on the proper path, would be grand. just grand. we'll have you back on the water in no time. either that, or we're all wet.

but this is all going to hinge on what those diagnostic tests say and what the surgical consult reveals. because if some of the nerve roots HAVE been pulled out and are in need of surgical repair, or some other obstruction is there which cries out for surgical remedy, well, then... you'll deal with that with the very best woman or man for the job that you can find. i know you will. and in that case, it would be surgery, then recovery, then rehab, PT/bodywork, etc., etc. and we will be right here for ya through all of it.

miles to go before you sleep!

sorry i'm so long-winded. it's a character defect. just read every other word. or ignore me entirely! lotz of people do; just ask my daughter, she'll be HAPPY to explain it to ya...

hahaha

alison
"Be Brave"

I think Alison covered most of it very well

I think looking around and finding the best {and knowledgeable} docs, PT, DC {if so inclined}, bodyworker etc - is a good way to go.

Until the neuro doc is found, tests done and decided upon-

Can your primary doc find a really good {expert/knowledgeable/skilled BP/neuro} PT so you can get started - but of course if you get into it and think it not going well -stop!
Or maybe you can track one down and ask Dr to rx the PT??

It really is amazing what a highly skilled and knowledgeable PT, DC, or DO {RLNP} can do - with the tools of LLLT {laser}, INF stim, Ultrasound and some manual triggerpoint.

But I am wondering if -as your Dr thinks -about the scar tissue, as the timeline is about right.
[(2) try not to worry too much about this because if symtoms resolved completely for seven months then nerve is likely in very good condition. Probably inflammation or scar tissue secondary to muscle injury causing nerve irritation or compression. (I don't know how much credibility to put into this advice, but he is quite a good doctor in my past experience),]