Kat-
I also injured myself trying to improve...I was taking yoga classes and struck a pose that didn't agree with me very well. Kept trying it for a few classes in a row before i realized it was what caused me so much pain. Well, I'll remember it from now on, lol....too bad for me.

anyhow, just wanted to reassure you that you are not alone.

As for removing the fibrous bands alone- once you have caused yourself a TOS injury there is compression within the scalnee triangle. Usually the muscles in the area are enlarged and everything is very crowded. The fibrous bands alone can help predispose you to an injury, but they will not fix big muscles or increase scar tissue in the muscles. The reason for a rib resection is that by removing the ribs and cutting the scalene muscles you remove two sides of the triangle. Done properly, this is a good way to remove *most* kinds of compression that can arise in the thoracic outlet. A scalenectomy relieves compression by only removing one side of the triangel (the scalene muscles) and therefore will not relieve compression as reliably, however it is a less invasive surgery. Different doctors have different opinions on which to do first and why.

My surgeon liked to do the rib resection first because 1. he had a good success rate with it, and 2. it was difficult to do a transaxillary rib resection once a scalenectomy had been performed due to the anatomy changes. Transaxillary rib resection is performed through a long tunnel and the surgeon must be very knowledgeable and very compfortable with what he is doing. A supraclavicular scalenectomy or rib resection offers the surgeon a clearer view, but, in the opinion of my surgeon (which is not shared by everyone), offers more chance of nerve damage due to the sturctures that must be dug through and for a rib resection also offers less ability to remove the rib, as the whole thing cannot be reached from above.

He drew some very good pictures on the exam table paper the day he explained to me why he does it the way he does... I still have that sheet

I personally would love to see a dr house episode on TOS. I have been thinking about writing up the basics of one...you know starting with thinking that the patient is having heart problems because they come in complaining of chest pain, moving on to some problem involving breathing, then bad carpal tunnel or cervical spine injury, and finally realizing it is TOS. It all ends of course with a spectacularly performed rib resection by Dr Ahn...since he lives in LA and all and of course the TV happy ending where the patient is 100% cured (damn TV) so we can still complain about how they got it wrong.



ah well...guess i have written a book here.

got to give these arms a rest!!!!

hI kAT,
i HAVE TO REREAD MY POST, LIKE YOU IT WAS LONG AND i NEVER READ IT OVER OR SPELL CHECK, LOL.
bUT ALL OF us have the fiborus bands, what I meant to say is half of society has "Short" band. In my daughters case on of these bands was caught in a spasm and pulled to the arm pit. During her surgery it was located and snipped. It snaked up into the body out of site at the armpit incision. Dr. Togut found it later at the collor bone area and measured it at only 1 1/2 inches long...
This was a good thread to start, lots of times so many of us are not cookie cutter people, We have a strang or rare anomolie in our bbody make up that a TOS incident incites. Hope you can stop the zingers,
Di

LOL... that would certainly be interesting! And yes, they would definitely pick the classic happy ending... no chronic, ongoing disability! Well... they do pick very rare and hard-to-diagnose conditions for that show... could it just be a matter of time before TOS shows up? Who knows!! We can hope. Would be great publicity for it (even if it totally misrepresented the cure rate). I think you should submit your script.

Thanks, DiMarie!

I post my "long post" not just for diagnosis.

If in reading it you see a test that you haven't had done, sometimes that can lead to a new answer for whatever is going on.

The reason I think it is so important to check all of those items, is that TOS can mimic so many conditions that CAN be easily repaired or MUST be taken care of by different medicine.

For instance, I just had all of my MRIs repeated because it has been years. They still ended up saying "just TOS", but my TOS symptoms have now changed, and at least I now have the "comfort" of knowing that it IS still "just TOS" that is causing such havoc in new areas of my body.

So for anyone who hasn't done all of the testing, it isn't there to make some doc a lot of money, it's there to maybe find out you have something much easier to get RID of, than TOS.

God bless you and I do hope you find more relief.

What about MR Neurography by Dr. Filler? Is that helpful in diagnosing TOS? Has anyone on this forum had an MRN? They do them in California. I'm in Canada and my insurance (even my private insurance) doesn't cover MRNs. I'm not sure about 3D MRI/MRAs, but if they aren't done in Canada, then I definitely know my insurance won't cover it. If they do them in Canada, then I'm covered, but only if I get it done in Canada. That's the general rule.

I was thinking MRNs cost around $3000, though could be completely wrong. $10,000 for the 3D MRI/MRA?? Yipes. I would literally have to win the lottery to make that happen!

Drs. Filler, neuro, Collins, radiologist, and Brantigan all do some kind of special "3d" imaging. I should call and get my name of them exact. Collins is the expensive one - but still I've known two people who got actually TWO of them through their insurance. (Time had passed on one, on the other a surgery so they were done again for update.)

I don't know how helpful they are, in the sense that neurogenic TOS like mine cannot be "seen" by imaging. So I had Brantigan's image and nothing came up.

But I've also had the MRIs with fluid and nothing came up on those either.

Except for the scalene block, everything of mine is normal. (Except for RSD changes you can see, different blood pressure on the arms, hhhm, can't recall what else.

Is there any way you can ask your question simpler for me because I didn't understand it, and I will think it through if you do. Sometimes these drugs...well, you know.

So what is bothering you MOST. Or Top 5 symptoms? anything to help us help you more.

Best of luck, Tam

Neuro TOS is done by a bunch of MICRO damage. Little tears, strains, done over time. YOu may never see them, never even know how many or if you have compressions or just damage.

Once they are damaged, they try to find new pathways. This in itself can cause more problems, as they MALFUNCTION and that's when I think a lot of us get RSD.

IF during this time you had a car accident or a fall I think you'd be a better candidate to find the source of the compression(s), but now, reading this very slowly and carefully, I seriously doubt you're going to find a compression. But if you haven't had an MRI done with imaging (to make sure a vein is being compromised) you should just for safety.

Hope this helps, God bless you. Tam

Hi,
TOS can come from Myofascial trigger points secondary injury. Release of these knots in the impacted muscles can have a dramatic positive improvement to your pain and increased range of motion. An extra cervical rib does not necessarily cause the TOS. An elevate first rib secondary to trigger points pulling the rib up makes the openings smaller and compress nerves and vascular bundles that pass through these openings. I would suggest you investigate Myofascial trigger point therapy before considering surgery because statistically, the results are not usually positive.

The trigger point is a hyper-irritable focus within the muscle or fascia that causes taut bands and characteristic, predictable, referred pain like that seen in the neck muscles. Trigger point referred pain does not follow typical dermatome patterns.
Trigger points cause the muscle to become shorter and tighter. This limits the function and mobility of the muscle which causes weakness, decreased circulation and pain. When injured, most tissues heal, but muscles learn they learn to avoid pain. This muscle memory can produce unexpected pain years after an injury has occurred, especially during times of physical and emotional stress.

Trigger Point overview Myofascial Trigger Point Therapy is a therapeutic discipline and technique used for the relief of myofascial (myo=muscle; fascial=connective tissue) pain and dysfunction. It is a modality resulting from the lifelong medical careers of Drs. Janet Travell and David Simons. Myofascial Trigger Point Therapy is recognized by the American Academy of Pain Management as a modality for the treatment of myofascial pain and dysfunction.

A certified Myofascial Trigger Point therapist will conduct a comprehensive postural evaluation and range of motion testing for specific muscle groups most likely causing your pain and dysfunction.

The actual treatment session begins with a patient history. Your pattern of pain is precisely documented, your range of motion is assessed and your muscles are palpated for the presence of trigger points. When a trigger point is located, a slow sustained pressure is applied. Initially, the trigger point may be very tender, but pain gradually decreases and fades as the muscle begins to relax. The referred pain will decrease and a specific stretch of the muscle will be done. This process of trigger point release and stretch decreases pain and restores normal functioning.

Once the trigger points are resolved in those muscle groups the pain is usually reduced significantly. The therapist will provide you with some easy to perform stretching exercises to keep you pain away and improve strength and range of motion. The therapist will also ask you a lot of questions to identify the perpetuating factors, causes of the trigger point and give suggestions to you to avoid those causes in the future.



Muscles and fascia work together in functional groups. When a muscle in that group gets a trigger point it impacts the function of that group and causes postural dysfunction. Therefore, the whole function groups of muscles and fascia have to be assessed. Many trigger points cause satellite trigger points in predictable patterns.

Tom Myers, wrote a book called "Anatomy Trains" which explains how we are connected from the head to the foot via fascia lines. Fascial is connective tissue that surrounds every tissue, bone and organ in the body.
There are superficial and deep front, lateral, spiral. The fascia and muscles along the fascia lines can develop Trigger points.

In your case you trigger points in your traps, levator scapula, scalene and other muscles in your, neck, upper back, shoulder, upper arms(lateral bicep), chest (pec major and minor) may pull your head forward and rounded shoulders along with winged scapula(?). The pulling of your chest muscles causes a chronic strain on the traps and upper neck muscles called locked long. You can treat the muscle say the traps via different trigger point release techniques with digital (finger pressure), vapor coolant spray/ice and stretch followed by heat, and if these don't work injection into that muscles trigger point. The traps will feel relief for a while then the pain will return because the trigger point has been reactivated by the pull of the chest muscles and most likely shortened rectus abominas, your six pack.

Therefore, the whole body posture (Hip/Pelvis anteriorally rotated?), range of motion and pain pattern/dysfunction must be assessed before treating a single muscle.

Going back to the anatomy lines I would look to see if you are pulled forward and treat the whole frontal line starting at you lower leg, via digital compression with active and passive stretch at the same time, then reassess the range of motion/function and posture. Then I would address your traps and posterior neck muscles to release those trigger points.

If you are interested you can find a therapist in your area. Please use this link
http://www.myofascialtherapy.org/home.htm.

If you have no one near you I would be glad to research with my network to see if there is a therapist in your area with the proper training to treat you.

You may want to research this type of pain and dysfunction. You may have access through your medical library to the Travell & Simons’ Myofascial Pain and Dysfunction Trigger Point Manual Volume 1: Upper Half of the body and Volume 2: The Lower Extremities ISBN 0-683-08363-5 and ISBN 0683-08367-8. These volumes cover most muscles and associated pain patterns in the body including those which cause your pain. The muscles cause about 90% of all pain felt in the body.

Feel free to contact me for additional information.

You may be interested in reading this earlier thread

Specifically:

By Dr. Richard J. Sanders, MD : October 30, 2000

The initial treatment of TOS is certain types {or modalities} of physical therapy {PT}. Over the last few years, we have learned that a few modalities of PT are effective, while MANY OTHER modalities are ineffective or can make the symptoms WORSE. The recommendations below are based on the experience of OVER 1000 patients who have received therapy for TOS.

RECOMMENDED MODALITIES:

1.) Neck stretching exercises. Holding each stretch a minimum of 15-20 seconds, using your hands to help hold the head in the stretched position, and NOT trying to stretch through severe pain. If a stretch HURTS, reduce that range of stretch. Do NO MORE than 3 repetitions at one sitting; do this 2-4 times a day or more. The 2 positions that are useful for TOS are: 1) Neck rotation and 2) Head tilting.
2.) Posture correction. Proper posture for people with TOS includes: 1) Head back, 2) Chin down and, 3) Shoulders relaxed in a neutral position, NOT STRETCHED BACK SO THAT THE SHOULDER BLADES APPROACH EACH OTHER, This position should be maintained as much of the time as possible when standing an sitting.
3.) Abdominal breathing: Practice this lying flat on your back on the floor.
4.) Nerve glides.
5.) Feldenkrais method. This is a total body approach of slow gentle movements of arms and spine with an emphasis on learning what motions bring on symptoms in your body and developing ways to avoid these motions. There is a national registry of Feldenkrais practitioners across the United States and practitioners in your area can be found on the Internet by looking up: www.feldenkrais.com

MODALITIES THAT OFTEN DON'T WORK AND CAN MAKE SYMPTOMS WORSE:
1. Strengthening exercises
2. Theraband use
3. Resistance exercises with machines
4. Neck traction
5. Exercises with weights
6. The concept of "No pain - No Gain"

The above are guidelines that have been effective in TOS patients. They will work for many people, but not everyone. Additional modalities of PT are indicated for other conditions that accompany TOS, such as fibromyalgia, shoulder tendonitis, cervical spine strain, and others. Therapy must be individualized and it is best carried out with the guidance of a physical therapist plus additional training in the Feldenkrais method, usually with a different therapist.

Much more information about TOS can be found in my book, "Thoracic Outlet Syndrome - A Common Sequela of Neck Injuries". The book describes the causes, symptoms, methods of diagnosis, treatment, results and complications of treatment, and other aspects of TOS. Because the publisher of the book sold out all his copies and decided not to reprint it, the book is no longer available at stores.



Best wishes

Thanks for putting extra thought into my situation, Tam (I wouldn't want anyone to strain their brains tooo hard over my original post!) I think you're absolutely on the right track about it being a micro damage situation in my case... like, continuous little assaults, but ultimately permanent damage IS being done. Sigh. I don't know if a micro damage scenario makes for a better or worse prognosis than a compression scenario. Something tells me it probably makes it all the more complicated because it makes it harder to tell where the problems are coming from! Still, I would have thought that both would show up on one of those MRI scans that is supposed to show the nerves really well. Oh well!