Thoracic Outlet Syndrome

[JJMacVay]

I am a 30 year old male and have been working in the consulting industry, requiring me to constantly work on a laptop, travel weekly, always be on the phone, multitasking, use non-ergonomic environments, etc.) for the last 7 years and for the last 5, I've been having problems with my upper left shoulder blade/thoracic area.  

I, at times, have constant pain in and around that same area - along with tingling, numbness, weakness, etc.  I have trouble sleeping and relaxing in general.  In addition, there are times when I have terrible stiff neck (though it really isn’t my next – it just feels like it, it seems) that lasts for weeks.  I’ve gone to many doctors and have tried the following with no ‘long-term’ success:

1. Various types of massage
2. Physical Therapy
3. Ultrasound
4. Acupuncture
5. Rolfing
6. Exercise
7. I’m sure there are others

I’ve been told by doctors (Northwestern’s Rehab Institute of Chicago, and Cardiovascular Center) that I have TOS.  My doctor has told me that surgery is the last possible option – and considering what I’ve already done above, I don’t know what else I can do to improve my situation.  I’m sick and tired of waking up sore and feeling like I’m 60 years old.

I am leaning towards having the surgery in a couple of months – but to be honest, based on my research, I’m very hesitant.  Can anyone offer any advice on some metrics that are out there in terms of the following?

1. Success Rates
2. Failure Rates
3. Who are the best doctors?
4. Patient Comments / Recommendations
5. Etc.

[Demiguise]

Well you certainly have quite the cunundrum. You're obviously
aware that posture isn't very ergonomic in any way that you've
described your work. You can get pillows etc. for travel or
night comfort but it's a bandaid. Sounds like the ol' computer
story I've heard from many reg. & laptop users. ? is, have you
totally researched TOS & it is final dx'd. Has anything been
mentioned abt 'pectoralis minor block'? It's a guided ultra-
sound injection into area of brachial plexus. This is where the
nerves pass into arms from neck via armpit. This sometimes will
confuse dx'd TOS. Did they do a Selmonosky Triad? 1, raise
hands above to ceiling ck. palms for 1 white almost cadaver-like
color compared to other hand. 2, ck. supraclavicular area for
lumpy tenderness. 3, hands extended, ck. 4th & 5th fingers for
numbness/color. Cause for (TOS) could be neural/vascular/
arterial/venous syndromes. Surgery is always the last thing in
this case since you will always have scar tissue & never be
completely pain free as long as you hunch over or repeat your
posture. Pain over the shoulder blade w/ 'other proof' of TOS
does say that if it were me, I'd make darn sure they were sure.
I'd ask abt the 'block'. Injections in the brachial plexus area
then wait a few days w/ rest (no computer). If feeling good,
you might consider surgery. ? is, what type are they talking.
Tenotomy for 'pectoralis-minor syndrome' is out-pt/30min?/3"
incision in armpit/1"muscle is cut at shoulder blade area & then
removed so it can't re-attach/very lo-risk/90% success. Make
sure it's a Vascular Surgeon & ck. records w/ MD board. Was the
ultrasound over the Subclavian artery? Do you hurt bad if you
reach high for something or just to comb your hair. Most w/ TOS
say that immediately. Reaching causes a nerve bundle type pain
of compression of vessels. Have you thought abt a body massage
pad for home use & a 2" memory foam pad does help lesson the
pressure on blade. Make sure you get copies of any scans/mri's
done. Ask what type surgery & where. I'd try the block first.
A C-spine mri should be done also. Either choice, you'll have to
alter posture. Maybe put laptop up on ph-bks once arrived. You
sound like you can google some of this. Also, use flat pillow
or muscles pull in neck & spine. Gd-luck.