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    Old 02-03-2009, 11:52 AM   #1
    BluBird
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    Thoracic-Outlet Obstruction syndrome???

    Thoracic Outlet Obstruction syndrome

    --------------------------------------------------------------------------------

    Hi,

    My Dr. says I have Thoracic-Outlet Obstruction syndrome.

    I have some questions:
    1) What type Dr. (specialist) should I go to for a more thorough exam?
    2) What tests should my Dr. have performed to diagnose?
    3) My Dr. sent me to a Physical Theparist who says he needs to push my first rib down some to free up the space and allow blood flow - he exerts a lot of pressure, pushing down on that area....Is that how this is treated?
    4) Any opinions about a Chiropractor?
    5) Should I consider changing Dr's as this one doesn't seem to want to order MRI, x-rays, etc.
    6) Any opinons on Family Practice versus Internal Med. Drs.?

    I've been having problems with both arms - they feel tired, making it difficult to perform day to day tasks. This has been going on since the end of Dec.
    I also experience pain on the inside of the elbow (where you bend the arm) - it makes my arm feel real heavy. Have a lot of discomfort around the shoulder area and across the collar bone area and side of neck.

    Thanks for any input.

    Thanks,

     
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    Old 02-03-2009, 01:56 PM   #2
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    Re: Thoracic-Outlet Obstruction syndrome???

    Hello and welcome. I have this problem myself. Mine started as a secondary condition to some problems in my spine and my anatomy. I am including your questions with my input:

    1) What type Dr. (specialist) should I go to for a more thorough exam?

    You should go to a neurologist or an orthopedic surgeon - spine specialty for evaluation.

    2) What tests should my Dr. have performed to diagnose?

    TOS is very difficult to diagnose. It also has symptoms similar to a few other disorders, including cervical probs. Basically they start by ruling out the related conditions. As a start they use xray, then MRI, then some nerve block studies, emg, and there are a few basic maneuvers they use to test your response. You cannot be diagnosed with this condition just by doing the maneuvers. My radial pulses were completely absent at my exam, although this is a hallmark of TOS, none of the doctors were willing to say I had it based on this - they said it is controversial diagnosis and it needs to be really investigated.

    3) My Dr. sent me to a Physical Theparist who says he needs to push my first rib down some to free up the space and allow blood flow - he exerts a lot of pressure, pushing down on that area....Is that how this is treated?

    Personally, NO NO NO!!! I would not let a PT do this maneuver, they can actually make your condition worse or cause damage especially since you have had not imaging done. Please consider not doing this without direction from a neurologist. There are a couple places that you could have the compression, even up at the clavicle. Very conservative PT involves exercises that strengthen your shoulder muscles to open the thoracic outlet, improve your range of motion and improve your posture. These exercises, done over time, will take the pressure off your blood vessels and nerves in the thoracic outlet. Relaxation and posture work to help you bring those shoulders down and open space.



    4) Any opinions about a Chiropractor?

    I do not want to dis chiropractic, I believe they have their place. This condition is not trivial to manage. First you need experts in this condition to say you have it, then decide what you need. Your primary care doctor is making an un-educated guess at this point if you have not have any imaging done.


    5) Should I consider changing Dr's as this one doesn't seem to want to order MRI, x-rays, etc.

    TOS isn't just something you guess at, there are a host of conditions that can mimic this. You need xrays and MRI as a starting point.


    6) Any opinons on Family Practice versus Internal Med. Drs.?

    I use an internist MD. I live in a medium size city and there seems to be a difference in the two. Many people I know who see family practice get referred out all the time for anything except: colds, flu, well checks, blood pressure management and that type of basic medical management stuff. I go to internist and she doesn't refer me until she has run a host of tests, done investigation and has the information to get me to the right specialist if I need one. I think she gets paid more for her specialty and can take the time to investigate my case, where family practice maybe can't spend the time they need based on how their practices are set up. All I know is she is really thorough and I have complete confidence in her care. That is the most important thing whether it is family practice or not. Just by the questions you asked I can see you do not think the doctor did what you would have expected investigating what is wrong with you.

    Also - true TOS because of 1st rib problems is more rare and more often it is because of other things. If you do end up having this, and they confirm it is your rib and someone tells you that you need surgery - find an extreme expert in Thoracic surgery. This is a difficult surgery and there are not that many that do it in the country. So go slowly there if you head that way.


    I hope I helped you. I will watch to see what happens with you. Good luck.

    Last edited by PNo; 02-03-2009 at 02:00 PM.

     
    Old 02-04-2009, 04:54 AM   #3
    BluBird
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    Re: Thoracic-Outlet Obstruction syndrome???

    Hi,

    Thanks for your response and the information.

    I don't have any faith in the first two Dr's that I've been to. Neither seem interested in doing more than having me take Motrin.

    I have an appt. today - it's with a Family Med. Dr - I do have concerns over a Family Med Dr versus a Internal Med. However, so far, I haven't had a Internal Med. Dr. that will take any action. I'm just hoping this Dr. will at least order MRIs and X-Rays.

    When I ask for a MRI (I'm going to make the suggestion if the Dr. doesn't) - what area should I ask for images of?

    Thanks again!

     
    Old 02-04-2009, 05:48 PM   #4
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    Re: Thoracic-Outlet Obstruction syndrome???

    It's kind of complicated so it could be they start with xrays of neck,upper thoracic and shoulder. THen depending they could do MRI of neck or thoracic, or shoulder. I would lean on pushing for a cervical MRI from the doctor based on what you described as your symptoms.

     
    Old 02-05-2009, 03:15 AM   #5
    BluBird
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    Re: Thoracic-Outlet Obstruction syndrome???

    Hi,

    I hate to be so much trouble and keep asking questions, but where is the thoracic region?

    I went to a new Dr. yesterday (the Family Practice Dr.). He seemed nice - he, at least, walked in, shook hands - introduced himself - then took a medical history, then listened (actually listened), did an exam very similar to the 2nd Dr I went to.

    He said he doesn't detect any "weakness" - I told him it's not really weakness as much as "tiredness". It feels like I've done something over and over until the arm is just so tired I have to rest it.

    He did a neck x-ray in the office - so he also seems to be thinking neck. However, they're looking stricktly at the neck - not at the shoulders or the area between neck and shoulders.

    He put me on a 8 day round of steroids. I asked about MRI's - he said to take the steroids and come back in two weeks - if I'm not better, he's referring me to a Neurogolist.

    I also have a rash on my neck that started about a week or so before these symptoms (probably coincedence) - this Dr. actually decided to do bloodwork to see if there's any chance they're related.

    All of this started when I was moving some furniture around - twice a day, every day for about 5 days - back during the last week of December. I keep thinking if I've done anything, it's over in my shoulders - but I guess since it's in both arms, they're thinking neck.

    What I may do is take the steroids and if I'm not better, go ahead and call before my appt. to see if he'll go ahead and order a referral to the Neurologist so I can at least get a appt. set up.

    Neither of the last two Dr's I've gone to have mentioned Thoracic Outlet Syndrome - I didn't bring it up because I wanted them to do an exam and make a decision without any influence.

    Thanks Again for all your help and information!

     
    Old 02-05-2009, 09:37 AM   #6
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    Re: Thoracic-Outlet Obstruction syndrome???

    Never feel bad about coming here and trying to get information and what others did in their search to feel better. That's why we all congregate here.

    I was super suspicious about that one doctor saying you has TOS and without any tests. I would expect exactly what happened at this current doctor. Since you have symptoms on both arms it is unlikely that it is "shoulder" because those are separate entities and it would be extremely unlikely you hurt both at the same time without some major trauma. It could be a strain.

    Thoracic is basically your chest height, those levels in the spine start from the base of your neck kind of right below where that little hump is on the back of your neck to about upper waist height (like the ribcage area).

    Neck problems show up in the arms and shoulders/blades. That's why they start there. It is also the most commonly injured location. The lower cervical levels C5-6, C6-7 are the most injured levels and if you feel on the back of your neck are about at that little hump at the bottom of the curve of your neck.

    Do you have any spine tenderness to touch? Do you have any pain or is it mostly weak "feeling"? (don't pay any attention to doctor saying you have no neurological weakness, plenty of people don't show weakness on the test but it "feels" weak to them). Also do your deltoids hurt?

    Do you live in an area where lyme disease is possible? That rash could be nothing or it could be related. Does it have a shape? Have you had any new headaches or fever? THis doctor is probably going to check for inflammation markers etc. I wouldn't automatically jump to lyme - just keep that in the back of the drawer in case you jump hoops and don't get better and they don't find anything else.

    Take the steroids and see if you improve. The doctor seems to be following standard practice - so that is better than the others you had.

    Last edited by PNo; 02-05-2009 at 09:41 AM.

     
    Old 02-06-2009, 04:27 AM   #7
    BluBird
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    Re: Thoracic-Outlet Obstruction syndrome???

    Hi,

    What scares me about the first Dr. is I know people who would take her word for a diagnois and never think about it.

    I had to go online and look at a diagram of the shoulder/arm area. On the left arm, I have a lot of discomfort in what they call "Subscapularis" area. In both arms, my bi-ceps feel tired. It's like you sat down at a weight machine that isolates the bi-ceps and just worked them to death - they just feel so tired that I have to rest after each activity. I also feel that in what they call the "Brachialis" area (the inner part of the elbow - where you bend the arm) - then, I also start having discomfort in the forearms - right now, my left forearm is starting to feel irritated and my arm (forearm down starting to feel heavy). My forearms almost feel like I have a sprain in them at times.

    My bi-ceps and inner elbow area just feels overworked. The forearms almost feel sprained (flexing my wrists is a little painful, etc).

    On the left side, I also have a lot of pain coming down my neck and across my collarbone area over to the shoulder (not a shooting pain - more a real tightness).

    I do sometimes feel almost a knot in the area of the neck/back you're talking about. It's about even with the shoulder blades, center of the back.

    I was a little concerned about choosing a Family Practice Dr. over a Internal Medicine Dr. However, at least he didn't blow me off like she did. I had gone to her for 18 years (I'm pretty healthy, rarely gone to the Dr. over once a year). I went to her back in '98 three times complaining of upset stomach - she kept writing it off and telling me to take Tums...I went out of town (the same day I saw her), wound up in the emergeny room in a small town - took that ER Dr less than 5 minutes to tell me I had an ulcer. It wasn't until I came back home and showed her his report that she ordered a Upper GI and sure enough, I had ulcers. I don't care if he does refer me out to a specialist for anything other than typical complaints. If the sterioids don't work, I'd rather go on to a Neurogolist for further tests.

    The Dr. gave me some crème for the rash. We'll see what the tests show. I'm also wondering if I could be having a reaction to one of my parrots - he has a lot of "dander" and he likes to rest in the area where the rash is. It could be the dry skin from winter, combined with his dander (a lot of people have a reaction to cockatoo dander) is causing it. I'm also washing that area with a anti-bacterial soap just after handling him, then putting the crème on it.

    This is just a little scary because I'm normally a pretty healthy person. I have about one cold a year and that's it. I normally go to the Dr. once a year for a physical.

    Thanks again,

     
    Old 02-07-2009, 07:31 AM   #8
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    Re: Thoracic-Outlet Obstruction syndrome???

    I have had this diagnosis also. Everything neckpatient said is right on. Please take her advice and see a TOS specialist before allowing anyone to do surgery.

     
    Old 02-08-2009, 05:13 AM   #9
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    Re: Thoracic-Outlet Obstruction syndrome???

    Hi,

    I've found Neckpatient to be very informative.

    I still don't know that I have this. I still I may have just injured myself back in December with some lifting - I lifted some objects over a period of a week.

    I've looked on a TOS board and there are not specialists in my area.

    However, I think my next step will be a Nuerologist. I'm going to finish this round of steroids and I may call and ask for a referral if I'm not better (not wait the additional week).

     
    Old 02-08-2009, 04:29 PM   #10
    BluBird
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    Re: Thoracic-Outlet Obstruction syndrome???

    What should I do now??? Here's the latest -

    just got a phone mesg. from the first Dr. I went to (my Internal Med. Dr. of 18 years) - she said she was in the office this evening following up on some paper work.

    She said she'd rec'd a letter from my physical theparist- he told her that he didn't believe that I had TOS and thought she needed to do further evaluation. I'm sure he didn't tell her that he was pressing down on my first cervical rib to try to lower it.

    I'm sure he wrote that letter after I called and cancelled my next appt.

    She then went on to say she saw where I had called and told the Dr. covering for her that I was in persistent pain. His recommendation was that I make an appt. and she didn't see where I had done that.

    She's thinking she'd like to send me to a Orthopedic surgeon for further evaluation.

    She said she's not sure if it's a blood flow problem or a problem with the nerves in my neck.

    What should I do at this point?

    I'd like to tell her that the theparist may have done more damage than good - he surely didn't know what he was doing.
    I'd like to tell her that the other Dr. didn't return my call - wouldn't discuss anything with me (said I could only discuss further testing with her)
    I'd like to tell her that I tried to schedule an appt. with her but it was going to be another two to three weeks before I could get back in

    I'm really torn in what to do...Do I stick with this new family practice Dr - who, by the way, can't seem to even diagnose a rash on my neck - his lab person has made a mess out of my arm - you wouldn't belive the ugly bruise on my arm where she drew blood -
    Do I tell her that I've gone to another Dr???? Should I give her another try?????The new Family Practice Dr is thinking neck area and his next step is a Nuerologist.

    Suggestions?

     
    Old 03-30-2009, 07:37 PM   #11
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    Re: Thoracic-Outlet Obstruction syndrome???

    Hi, i'm new to TOS, but have it, and I'm looking for some good descriptions/websites on it, I'm under a chripractic college's care and am glad, they are doing a lot of muscle stretching across the front/back/collarbone, and not manipulating, 2 torn discs. c5-6. I'm just trying to learn more.

     
    Old 03-31-2009, 03:22 PM   #12
    BluBird
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    Re: Thoracic-Outlet Obstruction syndrome???

    Hi,

    Well, a lot has happened since I posted on this web site.

    The good news is that I don't have TOS. The bad news is I have Dermatomyositis.

    I would start a new thread and ask for information - I did receive some very good information from this web site.

    To me, one of the most important things, would be to be comfortable with the Dr's you're seeing and feel confident with them.

     
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