Here's an interesting article from a chiro. journal. "THORACIC OUTLET SYNDROME: PUZZLING"

Here's the link:
http://findarticles.com/p/articles/m..._n9386836/pg_1

Has anyone had or heard of "drooping shoulders" post rib resection that are mentioned in the article?

"Until a few years ago, thoracic outlet syndrome was often treated surgically. Even now; in the case of 'first rib syndrome,' surgical resection of the extraneous rib is sometimes done, but it hasn't proven particularly effective, says Dr. Saboe. "It causes drooping of the shoulders, which leads to continued traction on the brachial plexus, and, therefore, continued pain and paresthesia. The outcome really isn't very good, and conservatively treated patients do just as well."

Nice article - I'll add it to our chiro links section.

I found these parts very interesting- my chiro does most of these suggested tx's -

[In addition, he suggests, the doctor of chiropractic can do a first-rib adjustment to create space so that the plexus isn't compressed. "You can also do some cross-cord exercises, making the contralateral scalenes contract and the muscles of the other side relax. Myofascial active release is also effective."

Dr. Saboe also recommends deep-tissue work for the trigger points. "I do digital pressure, cross-frictional massage, and origin and insertion work-which means doing friction massage of the origin of the scalenus muscle and the insertion-with hopes of stimulating the tendon apparatus so that the muscle relaxes," he says. "Many times I also use interferential, high and low mode, for 20 minutes after an adjustment and before the soft tissue work, to try to loosen up all the musculature. If there are truly active trigger points in the scalene musculature, the latissimus dorsi and superspinatus, pulse ultrasound in combination with negative galvanic electrical stimulation is very beneficial."]

[Dr. Tyer also advocates assigning patients an exercise plan. "Extensor exercises, for example, are good, "You want to strengthen the extensor groups of the neck. When you do that, the flexors have to inhibit, they have to release. If the thoracic outlet syndrome was not caused by trauma, it's often caused by poor posture-certain muscles are starting to contract because their extensor groups are weak," he says. "When someone presents with anterior rotated shoulders and the head carriage is forward, everything's closing up in the anterior group and the extensor groups become weakened. Extensor exercises can help take care of some of these anterior contractures."]

["In my experience, you don't cure thoracic outlet syndrome, you manage it," says Dr. Saboe. "You give symptomatic relief, and the symptoms will slowly return, although in every case I've seen, they never return as intensely as they were before-provided it's managed properly. If the patient comes back in, that patient will respond to palliative and supportive treatment. I haven't had a single case that's progressed or gotten worse. The only cases I've ever heard of that have deteriorated are those in which the first rib was resected."

Once the initial presentation of TOS is resolved, Dr. Murphy recommends that the practitioner look for underlying factors that may serve to perpetuate the problem or promote its return. "These may include cervical or scapular instability residual joint dysfunction in the cervical or thoracic spine, and any residual neural tension that can be detected through the brachial plexus tension tests," he says.

For long-term management of thoracic outlet syndrome patients, Dr. Saboe also recommends supplementing with B complex. "In addition, if patients are really acute, I also use enterically encoded proteolytic enzymes," he says. "They're natural anti-inflammatory agents."]

On one of the pages was this article/link too- thought I might as well add it on here-

Thoracic Outlet Syndrome PART I: A clinical review
http://findarticles.com/p/articles/m...01/ai_n9386854

I think all I can say is WOW. That was alot of information. It explains alot. First, I had the rib resection and yes my right shoulder droops. My bra strap continually falls. I used to keep putting it up but don't bother anymore. Noone sees it anyway. I'm going to print this for my neurologist. He kind of defers to Dr. Togut and he may find some of this interesting and useful Thanks. Linda

I never had surgery but my R shoulder has drooped since my R shoulder "sprains" {that's what W/C called them LOL -both times} or at least that's when i noticed it was lower than my left. and I just had "wrist strains" too- yeah right...

My mom has a droopy shoulder too- I just noticed that when shopping for jackets with her 2 yrs ago.

It's surprising how many people do have uneven shoulders.

i have to chime in here. briefly (stop laughing). basically, i thought both of these articles were fairly informative and i thank both fern and jo for posting the links to them.

but as someone who has been dx'd with "true neurogenic TOS" (albeit many years after the onset of my sx, mind you), i have GOT to take issue with the statement made in both of these diatribes that this "rare" form of TOS (another questionable characterization, but i'll let that go, for the moment... where IS jane when i need her?) is virtually "PAINLESS."

WTF?!?!?!?! i beg to differ, folks. there is nothing about it painless. and just for the old recordbook, the man who coined the phrase, "true neurogenic TOS," the late dr. asa wilbourne of the cleveland clinic, was a NONBELIEVER.

yes, you heard me. so unless you have vascular TOS or like me, a badly atrophied hand and could have presented visible proof to the man, he would have laughed you out of his office if you came to him seeking tx for TOS. and his legacy lives on in medical articles like these, where the form of TOS which bears his "signature" is still being characterized as "painless" (it isn't), unilateral (another lie), striking women ages 35 - 55 (i was 25) who have cervical ribs (which i don't).

but get this - there's no other way to get the hand atrophy, according to the good doctor W., other than to have this rare form of thoracic whatlet? syndrome... so i'm stuck with "his" dx. i think i'm starting to hate this, the more i learn about the man.

so here's the thing. you tell me. who said this?-

i have met the enemy... and he is us!



[why, 'twas POGO i do believe.]

now i will say that my neck, head, shoulder, upper back, arm pain, etc., was/IS so bad that the wasting of the hand muscles has been fairly painless in comparison. perhaps that is what was originally "intended," but given dr. wilbourn's battles with the good dr. david roos i RATHER DOUBT IT, and that is not what the material in question states at all, is it.

but, hell. now that the hand is "end-stage," it friggin' aches all the dang time! it's ALL pain and NO "less"!!! so there you have it. i said my piece. OK not briefly. shoot me!

alison
"Be Brave"

Sea Pines. you took the words right out of my mouth


"true neurologic TOS-a rare, usually painless disorder"

Yeah right!

Oh yeah i saw that too and thought is that a typo??

Of course they could have clarified too- that there are varying levels of entrapments or compressions...the milder forms being less painful and to the extreme stage as being very painful.