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Questions posted in the
Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
Question Title: Can I be sure this is thoracic outlet syndrome following cervial fusion?Forum: Neurology Forum
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I had cervical fusion of C5-C6 in June of this year. 2mos. post-operatively I began to have pain in my posterior neck, shoulders and arms which so developed into weakness,aching, and sometimes tingling from hands to neck. At nite my arms seemed to take turns falling asleep and would wake me from the aching. At this time I also developed what felt like a twinge of nerve sensation in my right upper inner thigh whenever I tilted my head downward. It would and does occasionally seem to happen in my lower leg also. I also get weakness in the right leg on occasion. Of note, the bone for fusion came from my right hip, but did not bother me more than seemed necessary. Except for the anterior neck incision coming open half way and the underlying sutures working themselves out thru the incision a month after surgery, there were no complications post-op except for intense vomiting after surgery x12 hrs, resolved with meds. There was alot of blood noted on the pressure dressing which was never removed during the hosp. stay. Have been to new Neuro surgeon since original surgeon felt "it must have been something did" and was then diagnosed with TOS. But, from what I have read, this would not affect my legs,nor should I have new symptoms like tingling/numbness of the tongue and some trigeminal pain. Referral to a neurologist for EMG/Conduction study shows definite problem in right and left with the right being the worst. Had MRI post-op (two months) stating unable to determine evaluate spinal cord conduction or something like that because of pt. movement, also could not confirm fusion as too recent. A BAER and SSEP test are scheduled. I am worried that we are not on the right path and I have already lost my job. I am in constant discomfort and the weakness keeps me from enjoying the things I like to do. I had a tooth filled one week prior to surgery and two weeks ago I had to have it pulled because it had simply died. I had so much pain trigeminally I couldn't tell where it hurt. My temple throbbed, then my eye,jaw sinuses, the tooth ended up being an incisor. The oral surgeon could not numb the tooth without sending severe pain thru the nerve. He suggested something was really not quite right about that nerve. So now I need help. Is this a combination thing, spinal stenosis, peripheral neuropathy, or what. Also, neurologist stated some of my original bloodwork came back marginal so additional bloodwork drawn, i.e. TSH T4 sed immunoelectro Q and two others if that gives any clues. I have been treated for hypothyroid following a surgery 15yrs ago, but studies 3 years ago were normal. Also, surgery was result of auto accident 2 1/2 yrs ago. One other note, my feet burn and ache, alot. None of this pre-operatively. Any direction or information would be appreciated.
Dear Leila: True neurogenic thoracic outlet syndrome is a very rare condition that causes weakness and atrophy of the hands and some sensory symptoms along the inner or medial side of the hand and forearm. It is quite unlikely that you have this problem, statistically speaking. In contrast there is a far more common "disputed" version of the thoracic outlet syndrome that is diagnosed by surgeons with relative ease; most neurologists with expertise in this area, no matter how hard they look, cannot find any evidence to support the diagnosis in these patients. I, as neurologist, strongly dissuade you against getting operated upon for thoracic outlet syndrome unless an expert neuromuscular specialist from a reputed academic neurology department diagnoses the condition with certainty after a very extensive and definitive EMG test, again performed at that academic neurology department. Unfortunately, surgery for the disputed version of the TOS is frequently performed in the US, occasionally with disastrous complications. The nighttime hand symptoms that you describe can potentially result from carpal tunnel syndrome which might need to be ruled out. The leg symptoms with neck movement most often results from minor or major involvement of the cervical spinal cord (Lhermitte's sign). I do not know what mignt be causing your face and tongue symptoms. Itis my sincere advice that you see a neuromuscular specialist in a reputed academic neurology department near you before you consent to any surgery.
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