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Neurology (Expert Forum)
Re: Thoracic Outlet Syndrome
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Re: Thoracic Outlet Syndrome
by CCF Neurology MD:NT, Jan 01, 1995 12:00AM
Posted By CCF Neurology MD:NT on January 08, 1999 at 19:32:30:
In Reply to: Thoracic Outlet Syndrome posted by Andy on January 08, 1999 at 02:16:44:
Hello, I have a question about Thoracic Outlet Syndrome. I am an aspiring musician and about four to five months ago I began to experience tingling and weakness in my hand/arm especially while trying to play my instrument. Interestingly enough I found the symptoms were worse when playing sitting down and that positional/postural change did improve symptoms somewhat. The tingling mostly occurs in the 3rd and 4th fingers but is sometimes present in the thumb, index, and middle fingers as well (never all 4 fingers at once). I do notice some weakness in my hand/arm when I'm not playing but symptoms are much more apparent while playing. The hand, arm and fingers just seem to fatigue quicker than normal. I don't feel as though I have as much endurance as I should. Here are a couple of things I should point out: Before all this started I would play for long amounts of time sitting in a "slumped" over posture with my spine bent and head pushed forward. I have heard this can contribute to TOS. Symptoms are definitely worse when I attempt to play in this "slumped" position. Some symptoms, however, always remain no matter what position I try to play in. Also, whenever I reach my arm behind my back and return it to it's original position I feel a very definite "SNAP" sensation (like a knuckle crack times 10) between my neck and shoulder which sometimes aggravates symptoms. Upon making the same movement with the other arm I feel nothing abnormal. Does this description sound like TOS? Numbness in hand/arm has been minimal during this whole experience. I have seen various MDs who are quick to point out the elbow, hand or fingers as possible culprits. Could they be overlooking something? Thanks for your time! Andy
Dear Andy:
The opinion of most neuromuscular experts is that true neurogenic thoracic outlet syndrome is quite rare. Intermittent symptoms of the fingers of the type you experience are far more commonly from entrapments of ulnar and/or median nerves. Some of these entrapments are not uncommon in musicians, may be are related to postures, pressure at specific points (such as the elbow for the ulnar nerve), and repetitive movements. A careful clinical assessment and a comprehensive EMG examination done by a neuromuscular expert can be most helpful in determining the cause. Appropriate treatment can be undertaken thereafter.
Thoracic outlet syndrome, in my opinion, is rather indiscriminately diagnosed (and also surgically treated) by some physicians. Surgery for such disputed or doubtful TOS can be potentially hazardous. I would strongly advice you to seek a competent neurological opinion prior to consenting to undergo any surgery for a nerve problem.
Dr. Richard J. Lederman (at the Cleveland Clinic) is a world-renowned expert on the neuromuscular disorders that can afflict musicians. In case you desire an opinion from him, you may want to call (800)223-2273, or (216)444-5559.
In Reply to: Thoracic Outlet Syndrome posted by Andy on January 08, 1999 at 02:16:44:
Hello, I have a question about Thoracic Outlet Syndrome. I am an aspiring musician and about four to five months ago I began to experience tingling and weakness in my hand/arm especially while trying to play my instrument. Interestingly enough I found the symptoms were worse when playing sitting down and that positional/postural change did improve symptoms somewhat. The tingling mostly occurs in the 3rd and 4th fingers but is sometimes present in the thumb, index, and middle fingers as well (never all 4 fingers at once). I do notice some weakness in my hand/arm when I'm not playing but symptoms are much more apparent while playing. The hand, arm and fingers just seem to fatigue quicker than normal. I don't feel as though I have as much endurance as I should. Here are a couple of things I should point out: Before all this started I would play for long amounts of time sitting in a "slumped" over posture with my spine bent and head pushed forward. I have heard this can contribute to TOS. Symptoms are definitely worse when I attempt to play in this "slumped" position. Some symptoms, however, always remain no matter what position I try to play in. Also, whenever I reach my arm behind my back and return it to it's original position I feel a very definite "SNAP" sensation (like a knuckle crack times 10) between my neck and shoulder which sometimes aggravates symptoms. Upon making the same movement with the other arm I feel nothing abnormal. Does this description sound like TOS? Numbness in hand/arm has been minimal during this whole experience. I have seen various MDs who are quick to point out the elbow, hand or fingers as possible culprits. Could they be overlooking something? Thanks for your time! Andy
Dear Andy:
The opinion of most neuromuscular experts is that true neurogenic thoracic outlet syndrome is quite rare. Intermittent symptoms of the fingers of the type you experience are far more commonly from entrapments of ulnar and/or median nerves. Some of these entrapments are not uncommon in musicians, may be are related to postures, pressure at specific points (such as the elbow for the ulnar nerve), and repetitive movements. A careful clinical assessment and a comprehensive EMG examination done by a neuromuscular expert can be most helpful in determining the cause. Appropriate treatment can be undertaken thereafter.
Thoracic outlet syndrome, in my opinion, is rather indiscriminately diagnosed (and also surgically treated) by some physicians. Surgery for such disputed or doubtful TOS can be potentially hazardous. I would strongly advice you to seek a competent neurological opinion prior to consenting to undergo any surgery for a nerve problem.
Dr. Richard J. Lederman (at the Cleveland Clinic) is a world-renowned expert on the neuromuscular disorders that can afflict musicians. In case you desire an opinion from him, you may want to call (800)223-2273, or (216)444-5559.
