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Neurology (Expert Forum)
tos dx - what to do - dr. opinion
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tos dx - what to do - dr. opinion
by gerddyone, Dec 20, 2002 12:00AM
Hello, I have read the archieves where it is said that true TOS is rare. I have had an abnormal nerve conduction study and recently had an abnormal vascular study (normal on the unaffected side). My ROM is limited because of a shoulder injury (and now frozen shoulder), which started this,so they want to repeat the vascular study (doppler ultrasound) after I have full ROM. The hand in the injuried side has numbness and tingling and gets really cold. PT makes those symptoms worse (they are the ones that wanted my to see a specialist). I have been doing trigger point injections to see if that helps. They are hoping that the muscle contractions are causing the TOS symptoms and that by reducing them they will go away. Since TOS is rare, am I overlooking something else? It has been 8 months since the injury occured. I had a neg. shoulder MRI. Now, with so many people involved I feel like I am going in circles. Will neurological symptoms disapper with PT? Does scar tissue from an injury form causing compression of nerves. At what point do you just accept the injury and learn to live with it (not something my doctors are suggesting). Is true TOS a lifelong problem? The more I learn the more complicated this gets. Thanks for any answers.
Doctor's Answer
by CCF-Neuro-M.D.-JT, Dec 26, 2002 12:00AM
TOS is actually a group of disorders that affect either the brachial plexus (group of nerves coming from the spinal cord to supply the arm) or the blood vessels to the nerves, or both. As I have not personally reviewed your case in detail nor have I examined you, I can only tell you about the different types and treatment options for each one. You will have to talk to your doctor to see which one (if any) you fit in and then find the appropriate treatment for you.
According to Dr. Wilbourn, one of the world's experts on the brachial plexus here at the Cleveland Clinic, it can be divided into the following groups:
1.Arterial - caused by large cervical rib or deformed thoracic rib pushing on one of the arteries in the neck/chest area compromising the blood flow. Diagnosed with neck XRay looking at the ribs. Referral to vascular surgeon. Symptoms are on and off. Could possibly be you.
2.Venous-spontaneous clot of the vein in neck/chest. arm becomes swollen and blue suddenly with dilated veins. Diagnosis with vascular studies and referral to vascular surgeon. You do not mention any swelling and blueness, only numb and tingling. Biut then you say abnormal vascular study. Don't know if this is you.
3.True neurologic TOS-Abnormal cervical rib or C7 vertebra with fibrous band compressing the nerve to arm. Wasting and weakness of hand muscles with some sensory loss. Diagnosed with routine neck XRays and EMG. Treatment with surgery. Doesn't sound like you, but possible as I have not reviewed your records in detail.
4.Traumatic-from clavicle abnormality like a fracture with injury to blood vessels or nerves in the area. Diagnosed with XRays of clavicle. Referral to surgeon - orthopedic, vascular or neurosurgeon.
These are the true types of TOS. If you really have one of these syndromes, they will not go away with PT and will likely need surgical intervention. The important thing for you to do is get the right diagnosis as this may not even be TOS. Consider a second opinion at a major academic center. Good luck.
According to Dr. Wilbourn, one of the world's experts on the brachial plexus here at the Cleveland Clinic, it can be divided into the following groups:
1.Arterial - caused by large cervical rib or deformed thoracic rib pushing on one of the arteries in the neck/chest area compromising the blood flow. Diagnosed with neck XRay looking at the ribs. Referral to vascular surgeon. Symptoms are on and off. Could possibly be you.
2.Venous-spontaneous clot of the vein in neck/chest. arm becomes swollen and blue suddenly with dilated veins. Diagnosis with vascular studies and referral to vascular surgeon. You do not mention any swelling and blueness, only numb and tingling. Biut then you say abnormal vascular study. Don't know if this is you.
3.True neurologic TOS-Abnormal cervical rib or C7 vertebra with fibrous band compressing the nerve to arm. Wasting and weakness of hand muscles with some sensory loss. Diagnosed with routine neck XRays and EMG. Treatment with surgery. Doesn't sound like you, but possible as I have not reviewed your records in detail.
4.Traumatic-from clavicle abnormality like a fracture with injury to blood vessels or nerves in the area. Diagnosed with XRays of clavicle. Referral to surgeon - orthopedic, vascular or neurosurgeon.
These are the true types of TOS. If you really have one of these syndromes, they will not go away with PT and will likely need surgical intervention. The important thing for you to do is get the right diagnosis as this may not even be TOS. Consider a second opinion at a major academic center. Good luck.
