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Neurology (Expert Forum)
Thoracic disc lesion or TOS?
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Thoracic disc lesion or TOS?
by MichaelaJ, Feb 21, 2005 12:00AM
Hi
I was recently referred to a rheumatologist due to ongoing problems with my left arm. 2 problems were found; supra scapular tendonitis (treated with cortisone injection) and the presence of an extra cervical rib (dr thinks I may have TOS so referred me for physio).
I am continuing to have a lot of pain down my left arm together with tingling/numbness in my hand (particularly my little and third fingers although present in all fingers and to a certain extent in the heel of my palm). I have had physio and traction with no relief and the physio thinks I may have a low cervical or upper thoracic disc lesion with nerve root involvement between C7 & T4.
She is going to refer me for an MRI scan but I would be grateful if anyone can advise what the treatment is for this?
Thanks
Michaela
I was recently referred to a rheumatologist due to ongoing problems with my left arm. 2 problems were found; supra scapular tendonitis (treated with cortisone injection) and the presence of an extra cervical rib (dr thinks I may have TOS so referred me for physio).
I am continuing to have a lot of pain down my left arm together with tingling/numbness in my hand (particularly my little and third fingers although present in all fingers and to a certain extent in the heel of my palm). I have had physio and traction with no relief and the physio thinks I may have a low cervical or upper thoracic disc lesion with nerve root involvement between C7 & T4.
She is going to refer me for an MRI scan but I would be grateful if anyone can advise what the treatment is for this?
Thanks
Michaela
Doctor's Answer
by CCF-Neuro-M.D.-CS, Feb 24, 2005 12:00AM
I cannot give you a definite clinical diagnosis without seeing you.
TOS (or Thoracic Outlet syndrome) is a commonly overdiagnosed problem, and is actually very rare. This diagnosis should only be made by an experienced neuromuscular physician with the aid of an EMG
The presence of an extra cervical rib does not necessarily mean that it is causing the symptoms - this anatomical variation is relatively common in the general population
The test of choice would be an EMG and nerve conduction study which will detect any significant pinching of the nerves, or nerve roots. Your local neurology center should be able to do this. An MRI will also be useful to look at the discs and nerve foramina (the openings through which the nerves go through to go down the arm from the spinal canal)
Treatment will depend on the cause
Good Luck
TOS (or Thoracic Outlet syndrome) is a commonly overdiagnosed problem, and is actually very rare. This diagnosis should only be made by an experienced neuromuscular physician with the aid of an EMG
The presence of an extra cervical rib does not necessarily mean that it is causing the symptoms - this anatomical variation is relatively common in the general population
The test of choice would be an EMG and nerve conduction study which will detect any significant pinching of the nerves, or nerve roots. Your local neurology center should be able to do this. An MRI will also be useful to look at the discs and nerve foramina (the openings through which the nerves go through to go down the arm from the spinal canal)
Treatment will depend on the cause
Good Luck
