I thought this would be a good topic for it's own thread.

Tam had a good listing assembled - here is a link to the cached version-
http://66.102.7.104/search?q=cache:j...&ct=clnk&cd=39

as I understand it -
we can link to the cached versions, but we cannot copy/paste another persons posts unless we get permission to do so.
we can copy/paste our own posts of course.

**********************************************
I'd like to add that sometimes a very HIGHLY SKILLED and EXPERT PT person can pinpoint the compression sites by doing the complete thorough physical testing and by using all the provocative maneuvers & positions.
JO

PS- I should add that the more in-depth testing is needed for proof on work comp claims or if there is severe pain, complicated or multiple conditions. {IMO}
__________________

very helpful site!!
G ~

Hello,

Correct me if I'm wrong...but I was advised that the best way to confirm TOS
is by having a image test....this was suggested by Peter E. to a friend of mine. The test is a MRA/MRI/MRV. It's very expensive and very hard to find
a lab that does the tests. I think it's better than someone just moving your hands and neck around !! TOS is so tricky

You're right - if you need a firm dx for ins or a legal case, WC or if you have severe sx.
Basically also to rule in or out any other separate or combined conditions.


I should have mentioned - that a complete history and detailed reported symptoms is taken into consideration also.
Along with the complete thorough physical testing using all the provocative maneuvers & positions.

in my case-
1 dr did only 1 pulse check on 1 arm- got no comment from her either way - I didn't know much about the testing then either.
the other dr just sent me to his adv PT guy {below}

the 2 advanced PTs {at separate clinics} and my chiro did both arms and the head/ neck/ c spine testing and rechecked 3x with the same results each time.

My thinking is if more people with chronic RSI get checked early for TOS types of symptoms - that maybe the possible cases could get turned around before TOS becomes severe.

Hi Ann
The problem I ahve seen is so often TOS is not diagx by these test. That the damage often cannot be seen, then it works against you. A patient had the testing and no results state TOS. IF you ahve a cervical rib, an anomolie that is visable, but so often the TOS problems just do not related to the teest unless vascular compression.

For example, if you are in a car accident or fall and have a stretch injury, this is not going to show up on the teest. Then your diagx is not going to be recognized if all the eggs in the basket are not on the MRA/MRV.
Having conclusive testing is great for litigation, but too often it is not going to help.

A good doctor that ahs a detailed history and can reproduce the symptoms and understands the symptoms and ahd hundreds of patients is best support in litigation.

I had a back lumbar injury in 2000; the doctor because of my symptoms sent me for an EMG/NVC test instead of an MRI. He stated the neuro symptoms I discribed would likely not show up on the MRI and then I would be denied a EMG/NVC test based on the lack of findings in the MRI.

He stated and rightly so, when the next test he requested was the MRI, that it showed mild bulging and other problems that could be related to DDD. Doctor stated, everyone over 20+ will start to show DDD. ALthough I did not experiance this pain prior to that car accident.

I was lucky that the EMG showed the L4/5 compression. If it had not, my claim would have been denied. Also, in my TOS, it did have some right side EMG positive testing, but it was almost two years post injury.

In police work, we had a tool for DUI's a breathalizer, or blood alcohol level test to tell us the blood alcohol level. But, it was our experiance to related the persons condition upon a traffic stop that established the probable cause.

Good police work and experiance was a much better tool in court as it was not a piece of equipment to challange.
There could be equipement error; operator error, sample error...
But, with visual hands on relating the slurred speach, reaching for ID could not hold on to documents or find the license, gave up looking. Fell out of the car when asked to leave the vehicle, odor of alcohol, the visible cans or bottles open....a cumlative findings establish the case, not the BAC test.

Every time I went to court with a test it was challanged. However, my credibility to first hand testimony stood up, even on appeal to a superior court by one attorney. The BAC was thrown out of .10 as too close to know the level at the time of the accident, it could be raising post accident. The victim had no problems with my testimony even though the test results were challanged and lost that piece of testing.

The machine it was stated could only test the level at the time tested...not if it was higher or lower at the time of the stop. This meant, if a person hit you and their BAC was .08, it could have been lower and in legal limit at the time of the accident; or it could mean that it was still going down and at the time of the accident over the legal limit.

But, the visible testimony or a professional nails them to being under the influance to the point of not being in control...thus the cause of the accident is their DUI state.

Sorry to use this analogy, but been in so many hearings over TOS and diagx and test, it makes so much sense to me. The best tool in a depsoition is a credible long time TOS specialist compared to a test. Good to have the test to support when it can, but very, often, most commonly it will not.

Di

Your right....it can be seen both ways. For me when I still had so much pain after my level 2 fusion on my neck and my spine doctor was so preplexed...he did the usual arm/pulse tests, but the weird thing was they were different each time. So for me I felt I needed more. But thank you for your response I have learned so much form this site and I appreciate everyone who takes time and pushes through the pain to write.....

Thanks

Ann,
I just realized you were talking perhaps about the loss of bruit test.
I do see your point as from support group Dr. Togut has told us that many NON-TOS patients have a positive response, and other TOS folks it can be unrealiable.

I meant in the testing of positonal; like the arms up in the stick up position, the one arm outstretched and look the other way. Looking upward, down and side to side. Also, the pin picks, with a one tip, two tip, and three or four tip point to determine lack of sensation to dull and sharp etc. This can take well over an hour or more to do the testing.

Can you imagine having a feather touch your skin and make it hurt, or a pin on it and it feels soft? This is a TOSer though. Sensory nerves are the first affected. The long term affect of Allodynia or RSD (CRPS I & II).

There are so many hands on test, to just use an unrealiable bruit one is a doctors lack of training.
I do however enjoy when the IME doctors are so inexperianced they base their total findings on this. An excellant start for a good knowledgeable doctor to discredit them.

Detailed history, hands on, replicating the numbness, pins and needles, tracing the paths of response when pressing on the brachial plexus are all a total look of the patient diagx. Good to if the EMG is is positive, or in vascular there are finding s to also support. Just for some that is not the case.

I think after the self learned information from sahring, reading and first hand experiance, we do find ourself more informed then much of the medical community to our situations.

Di

This might be a helpful article to print and bring to your Dr. for guidance of different imaging modalities to help diagnose TOS

http://www.acr.org/~/media/ACR/Docum...etSyndrome.pdf