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Old 03-20-2011, 07:00 PM   #1
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Thoracic Outlet Syndrome

Hi There. Does anyone on this board have Thoracic Outlet Syndrome or know anything about it? I searched the board and there are a few threads from many years ago. I believe I have this disorder or something very similar. I am having a hard time getting doctors to listen to me. I have had two cervical spinal surgeries (fusions) that I was told will solve my pain but they haven't. It's hard to find information on this. I have read a bit about it and it looks like there aren't a lot of doctors who know a lot about this syndrome. Can anyone please tell me if they know anything about it? Thank you

 
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Old 03-20-2011, 08:08 PM   #2
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Re: Thoracic Outlet Syndrome

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Originally Posted by Toonces1 View Post
Hi There. Does anyone on this board have Thoracic Outlet Syndrome or know anything about it? I searched the board and there are a few threads from many years ago. I believe I have this disorder or something very similar. I am having a hard time getting doctors to listen to me. I have had two cervical spinal surgeries (fusions) that I was told will solve my pain but they haven't. It's hard to find information on this. I have read a bit about it and it looks like there aren't a lot of doctors who know a lot about this syndrome. Can anyone please tell me if they know anything about it? Thank you
Nerves and blood vessels emerge from the upper chest and enters the upper limb. Where the site of compression is and the structures involved gives a veriety of clinical signs and symptoms. You say there arn't a lot of doctors who know a lot about this syndrome. That is perhaps a bit unfair to the docs as this is a most confusing condition. Complaints are often vague and contradictory. One question, is it nerves or blood vessels? Is there a thrombosis? although that is usually an easy one. Even with sophistocated tests it is not easy to diagnose. Also there are about three or four sites where neuovasclar compression can take place. If it is the blood supply it can be a dull ache, hand odema and a somewhat swollen viens. Nerves are somewhat different, intermitent, tingling on the little finger side of the hand and worsening with your hand above your head. This may give you something to notice and you can relate your findings to your doc.
James

 
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Old 03-21-2011, 06:34 AM   #3
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Re: Thoracic Outlet Syndrome

Yeah my dr. thinks I have it. Tests tomorrow. I'm in a great deal of pain right now, waiting for the percocet to kick in. I've had this chronic pain in my arm for 2.5 years now, I've had every test in the book it seems. After an EMG I was diagnosed with carpal tunnel syndrome, which can cause arm pain. I had CT release surgery, which may or may not have helped the pain - it's different now. A year ago, the pain was so severe that I would seriously scream into my pillow, almost called an ambulance a number of times because I couldn't deal. I was on morphine, which I hated so I quit that. That pain was daily - started right in my upper arm/shoulder, like where you'd get a tattoo. That's where it is now, but less severe. It moves around though - and it hurts all the way down to my hand. By move I mean it can move from that upper arm area to under my arm, to the back of my arm and on down to my forearm. What's weird is when it's really bad, I can feel it in the side of my face and the outside of my ear. Right now, it feels like someone is driving a big blunt nail right into my arm. In the past I was on neurontin, which I hated, but it did help - just made me tired and stupid, my brain just didn't work right. I have been taking percocets for 2.5 years, but only when it hurts, which granted is daily, but when I can go without, I do. Last night I actually went to sleep without taking them which always thrills me because it's usually the worst at night. Of course I'm making up for it this morning, called in for this morning because I can't work or drive til they wear off. I really hope it's TOS. I don't have a cervical rib, and I sure as heck wont have surgery for it. I was told, if the tests are positive, I would have a scalene block - a shot of bottom in the scalene muscle. Good lord, if that's all it takes to alleviate this horrible pain, I will seriously do back flips. I'm so so sick of hurting. But the test is they'll put a pulse-oximeter thing on my finger than make me do some exercises to see if the amount of oxygen in my blood decreases. I was telling my dr that I have started working out in the past couple months, and doing certain exercises, particularly lying on the floor with my arm straight over my head on the floor then raising it and touching my toe on the opposite foot which will be lifted in the air (for abs). I won't do that exercise because it hurts without fail. But I take a percocet before I work out because my arm always hurts. Anyway, long winded response for ya. Good luck getting you dr to listen. That is SO frustrating, I know. Ive been saying I think it's a pinched nerve or something in my shoulder since Day 1, and now, finally, they're considering it may be. I just want to be pain and drug free please.

Last edited by MyEye!; 03-21-2011 at 06:41 AM. Reason: A shot of bottom - should be a shot of Botox, hard to edit on an iPad

 
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Old 03-21-2011, 06:42 AM   #4
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Re: Thoracic Outlet Syndrome

A shot of Botox in my scalene muscle. Sorry, autocorrect got me.

 
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Old 04-07-2011, 05:52 AM   #5
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Re: Thoracic Outlet Syndrome

yes

id look up manual therapists..doctors are complete morons with this go to a good physical thearpist and dont let them tell you to lift weights!!!!!!!!!!!!

 
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Old 04-07-2011, 07:55 AM   #6
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Re: Thoracic Outlet Syndrome

I was diagnosed on Tuesday 4/5 with Pectoralis Minor Syndrome by Dr. Sanders in Denver. He's the major specialist on this. Treatment is stretching! So not thoracic outlet for me. We'll see if the stretches work, should take a couple weeks I was told. He didn't say to stop working out or anything.

 
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Old 04-07-2011, 05:53 PM   #7
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Re: Thoracic Outlet Syndrome

Quote:
Originally Posted by MyEye! View Post
I was diagnosed on Tuesday 4/5 with Pectoralis Minor Syndrome by Dr. Sanders in Denver. He's the major specialist on this. Treatment is stretching! So not thoracic outlet for me. We'll see if the stretches work, should take a couple weeks I was told. He didn't say to stop working out or anything.
This is interesting, there is no muscle testing position which will enable you to distinguish it from pec major very easily. Pectoralis minor draws the shoulder blade forwards and downwards. If the shoulder blade is held more rigid by other muscles it will elevate the ribs. Can you remember what you did, if anything to get this condition. Also where is your pain.
Pec minor is different from thoracic outlet as it is external to the ribs.
James



























this is interesting

 
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Old 04-07-2011, 10:02 PM   #8
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Re: Thoracic Outlet Syndrome

It has to do with the nerve running right below the Pectoralis minor. The median nerve gets irritated by the muscle. This is how I understood it anyway. As for my pain, I get excruciating pain down my arm to my hand which will getnumb and tingly, and pain under my arm as well.

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Originally Posted by james079 View Post
This is interesting, there is no muscle testing position which will enable you to distinguish it from pec major very easily. Pectoralis minor draws the shoulder blade forwards and downwards. If the shoulder blade is held more rigid by other muscles it will elevate the ribs. Can you remember what you did, if anything to get this condition. Also where is your pain.
Pec minor is different from thoracic outlet as it is external to the ribs.
James



























this is interesting

 
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Old 04-10-2011, 12:32 PM   #9
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Re: Thoracic Outlet Syndrome

What kind of specialist are the doctors who diagnose these conditions? I am not close to Denver so I can't go there. I'm in the Milwaukee/Chicago/Madison area. Is this a neurologist, a thoracic surgeon????

 
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Old 04-10-2011, 12:38 PM   #10
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Re: Thoracic Outlet Syndrome

Also, what tests did you get done or do in order to diagnose this? I have major pain in the upper thoracic/scapular area, under the arm and in the front and back of the armpit, down the back of my arm to the outside of my elbow. It doesn't hurt too much into my hand, but when I have my arm up my pinkie falls asleep. However, the main thing that can make the difference in my pain is if I put my arm over my head, my pain gets dramatically BETTER. My surgeon told me this is called the "hyper-abduction sign" but he didn't say much more than that. What does is mean? I need help... I try to do everything right-handed so I can walk around and sit with my arm over my head, but it's hard to type that way. If I am forced to sit with my arm hanging down at my side, I will get excruciating, mind-blowing pain. Lift my arm- major relief. 3 years now and I can't get a doctor to listen to me that maybe, just maybe, this isn't from my neck (2 surgeries later).

 
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Old 04-10-2011, 01:24 PM   #11
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Re: Thoracic Outlet Syndrome

I believe Dr. Sanders is a vascular surgeon. If you call his office - perhaps they can refer you to someone near you? 303-388-6461. They're very nice.

As for the tests he did on me - this is what it says on the narrative report I received:
Grip -- R was 70lbs / L was 50lbs
Scalene tenderness - checked bilaterally
tinel's over plexus - checked bilaterally
direct plexus pressure - checked bilaterally
shoulder tenderness -- checked bilaterally
arm abduction - checked 180degrees bilaterally
neck -- checked full range of motion
head tilt - left and right
upper limb tension test
chest wall - checked for tenderness
axillae - checked R and L
trapezius tenderness - checked L and R
rhomboid tenderness - checked L and R
spine -- checked for tenderness cervical and dorsal spine
hands - did a tinels and phelans
elbows -- did a tinels and checked for epicondyle tenderness
pronator tunnel -- tinels
radial tunnel -- tinels
sensation in hands
90degree AER -- abducted arms to 90degrees in external rotation

And he gave me a left pectoralis minor block of 4cc of 1% Xylocaine in the left pec-minor tendon area.

Not sure if that info will help but maybe you can take it to a vascular surgeon near you and see what he/she says.

On this for me it says under Impression - Left pectoralis minor syndrome. Under recommendations it says a stretching program for the next 3 months, quite possibly will clear up symptoms, if not pectoralis minor tenotomy may be a possibility (no f'in way)

Good luck.

 
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Old 04-10-2011, 01:43 PM   #12
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Re: Thoracic Outlet Syndrome

Also - this site is very helpful -- poke around on it:
http://www.atosa.org/patient-stories1/main/

 
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Old 04-10-2011, 03:07 PM   #13
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Re: Thoracic Outlet Syndrome

Quote:
Originally Posted by Toonces1 View Post
Also, what tests did you get done or do in order to diagnose this? I have major pain in the upper thoracic/scapular area, under the arm and in the front and back of the armpit, down the back of my arm to the outside of my elbow. It doesn't hurt too much into my hand, but when I have my arm up my pinkie falls asleep. However, the main thing that can make the difference in my pain is if I put my arm over my head, my pain gets dramatically BETTER. My surgeon told me this is called the "hyper-abduction sign" but he didn't say much more than that. What does is mean? I need help... I try to do everything right-handed so I can walk around and sit with my arm over my head, but it's hard to type that way. If I am forced to sit with my arm hanging down at my side, I will get excruciating, mind-blowing pain. Lift my arm- major relief. 3 years now and I can't get a doctor to listen to me that maybe, just maybe, this isn't from my neck (2 surgeries later).
You seem to have a seventh cervical root. Your pain is in the place you would expect.
The givaway is the lessening of pain with the had above the head. In the roots above at say c5 and 6 the nerve is stretched with the hand above the head, in the 7th it is more relaxed up above the head. Try this test. Elbows to your side and forearms out in front. Have your partner make a fist under your fists. You slowly and steadily push down as hard as you can. See if both arm,( triceps), have the same strength and if you have pain doing it. Let us know.
James

 
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Old 04-12-2011, 08:44 PM   #14
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Re: Thoracic Outlet Syndrome

I have not tried that test yet, but I will ask my husband to test it with me tomorrow. I do think that probably my left arm (the side with pain) is weaker in this position than my right. I don't know how much of that would have to do with my being right handed, but we'll see. I had my fusions at C5-C6 and no one can seem to get past that. I have suggested other levels might be the problem, or as I suspect, an upper thoracic/brachial plexus thing. My doctor has agreed yesterday to refer me to Mayo Clinic for full testing and diagnosis. I'm hopeful they will uncover what has been plaguing me for these years. Thanks for all your helpful info.

So the nerve is the C6-C7 nerve, or the C7-T1 nerve that is suspected?

 
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Old 04-13-2011, 11:29 AM   #15
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Re: Thoracic Outlet Syndrome

Quote:
Originally Posted by Toonces1 View Post
I have not tried that test yet, but I will ask my husband to test it with me tomorrow. I do think that probably my left arm (the side with pain) is weaker in this position than my right. I don't know how much of that would have to do with my being right handed, but we'll see. I had my fusions at C5-C6 and no one can seem to get past that. I have suggested other levels might be the problem, or as I suspect, an upper thoracic/brachial plexus thing. My doctor has agreed yesterday to refer me to Mayo Clinic for full testing and diagnosis. I'm hopeful they will uncover what has been plaguing me for these years. Thanks for all your helpful info.

So the nerve is the C6-C7 nerve, or the C7-T1 nerve that is suspected?
Between C6-C7= C7 nerve root.
James

 
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