Upper Back Pain, Thoracic
Posted on: Tue, 08/19/2008 - 14:39
TOS question

I am already a cervie and have been having left shoulder/arm pain....ortho has me going to PT and have been going for 2 weeks now....she is a very good PT person and has done numerous exams on me....today she did a few more exams that were kind of strange and she thinks I have thoracic outlet symdrome....not sure if I should be happy or sad....I have been thinking for the last couple of weeks that it was my neck again....I have a fusion C4-C7....this thoracic thing has me all confused....what are the test for this as far as xrays or CT's??

Sharon


Posted on: Tue, 08/19/2008 - 15:24 #1
TOS

Hi Sharon,

TOS is still a pretty big "catchall" for many docs and PT's. I had a neurologist diagnose me with Vascular TOS in 1994 without using any imaging studies. No other doc has said I have it, after a laundry list of images and tests since. I just think the guy was trying to put a fancy name on problem without looking further. One of the more common ways TOS is looked for, is by MRI of the brachial plexus. One consideration, is since you just had surgery at C4-C7, there might be some muscular or vascular compression, mimicking TOS to the PT. Just a thought anyway. I'm not a doc, just another spine health member.

Anyway, here's an abstract from the national Institute of Health on the 3 accepted types of TOS and recommended ways to investigate for diagnosis.

NIH wrote:
Neurogenic TOS has a characteristic sign, called the Gilliatt-Sumner hand, in which there is severe wasting in the fleshy base of the thumb. There may be numbness along the underside of the hand and forearm, or dull aching pain in the neck, shoulder, and armpit.

Vascular TOS features pallor, a weak or absent pulse in the affected arm, which also may be cool to the touch and appear paler than the unaffected arm. Symptoms may include numbness, tingling, aching, and heaviness.

Non-specific TOS most prominently features a dull, aching pain in the neck, shoulder, and armpit that gets worse with activity. Non-specific TOS is frequently triggered by a traumatic event such as a car accident or a work related injury. It also occurs in athletes, including weight lifters, swimmers, tennis players, and baseball pitchers.

TOS is more common in women. The onset of symptoms usually occurs between 20 and 50 years of age. Doctors usually recommend nerve conduction studies, electromyography, or imaging studies to confirm or rule out a diagnosis of TOS.

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"I tried to puree a rock...it didn't work..."

Posted on: Tue, 08/26/2008 - 15:37 #2
EMG and NCV

My doctor referred me to a neurologist for nerve conduction velocity and electromyography tests to rule out TOS.

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DDD, cervical spondylosis, radiculopathy, lumbar disc protrusion and lumbar spinal stenosis at L4-5, arthritis, carpal tunnel syndrome, double crush syndrome.

MRI's, EMG, NCV, X-rays.

Physical Therapy, anti-inflammatories, heat, traction, lots of walking, weight loss.