TOS surgery

[Sue Matherne]

I have had problems for the last year with numbness/pain in both arms and hands. The numbness in the third and forth fingers and down that side of my hands never goes away. I am a programmer and I was also in a car wreck 10 years ago where my head hit the windshield.  I have been to orthos, neuros, rheumatologists, etc. The last doctor I saw was Dr. Urshell, a cardiovascular thoracic surgeon at Baylor in Dallas.  He diagnosed me with TOS.  He had me go to a specific Rehabilitation Dr. - Dr Crane & have an EMG ( I had 2 done previously by a neuro and they did not find anything specific) & NCV done.  This EMG seemed to be a more extensive one though - he tested up into my neck and shoulder area where the others stopped in my arm. The day I had it done was probably one of the worse days I have had as far as pain/numbness/headache, etc.  Dr Urschell did some other tests when I saw him and he told me that my NCV readings were way below the normal of 85 - I had 30 on my left & 50 my on right.  He said that if you are under 60, PT will not help & that I need to pursue surgery.  He also said he thought it was work related.  I talked to Dr Richard Sanders on the phone and he has suggested thought that I should pursue PT.  He said the NCV test that Dr Urschell uses is not one that is re-producable and is not widely accepted.  He suggested I see a Dr Hempel at Baylor for a second opinion.  I am getting more confused and do not know what to believe at this point.  I have been diagnosed and treated so far for carpal tunnel and arthritis, but I do not think that either one is correct - neither one of the treatments seemed to truly help me, and the symptoms did not completely fit.  The TOS symptoms sound more like what I am experiencing, but how do I know what is the right course of treatment?  How do I know if this is really work related - I do know that I am in more pain and have more significant numbness when I have been keying for a length of time.  Any info, opinions, or resources you can refer me to would be appreciated.

Thanks,
Sue Matherne

[CCF Neuro[P] MD, RPS]

Dear Sue Matherne:

The TOS syndrome that is of neurogenic origin is actually very rare and unless the EMG is classic for TOS, another diagnosis must be sought.  There should also be sight muscle atrophy and weakness of the hypothenar, interosseous, adductor pollicis, and deep flexor muscles of the 4th and 5th digits.  It is a lower trunk of the brachial plexus and ulnar nerve.  I am not sure what velocities corresponded to which nerves.  The symptoms you describe may be TOS but also may be strictly ulnar.  I would get the second opinion as previous EMG testing had proved negative while the symptoms were present (albeit intermittent).  The values on the NCV do not seem too far off, and depending on your age may or may not be that abnormal.  Get the second opinion.

Sorry, I am not much of a help. However, there are more people without first ribs than need to be, because of faulty diagnosis.

Sincerely,

CCF Neuro MD