Mixed opinions - Back home from TBI -

[KBear]

I hope my tenture as a spiney with my 2 back ops still considers me a part of this forum the last one being my ADR. I feel for all who are in this boat no matter what the issue for the pain is. My prayers go out to all of you.
Jill

I don't know how I missed this. Of course you are one of "us"... not the best club to be in; but if you have to be in it, this is the place to be! LOL Pain is pain, doesn't matter where, how bad or how often, it hurts and it sucks! We are here to support you, regardless of where the pain is. Best of luck on a quick recovery! Sounds like you are doing great.

[cavalier]

Thanks K Bear. My concern is the overlap of someone having Cervical issues / TOS issues they really do mirro one another so it can be someone can have the wrong surgery or maybe not the most pressing surgery especially if they have cervical findings on MRI.

Am posting this for a bit more info on TOS -
Subject: 3 points good explanation for what happened to me

Thoracic Outlet Syndrome
What is Thoracic Outlet Syndrome?

Thoracic outlet syndrome is caused by compression of the artery, vein or nerve in the thoracic outlet (the area just above the collar bone, between the neck and the chest.) 1- *Sometimes the compression is caused by an anomalous (extra) rib or abnormal bony anatomy after a clavicle (collar bone) fracture or shoulder surgery, or sometimes it is caused by enlargement of the scalene muscles of the neck. Many people with TOS have a history of whiplash trauma (motor vehicle accident, fall or assault) or repetitive activity of the arms (word processing or filing), particularly overhead activities (lifting).* I had a couple of MVA’s & a fall when I broke my 5th rib July of 08. plus the extra rib, along with many yr’s of painting, typing & lifting grooming etc.
Symptoms are dependent on which structure (artery, vein or nerve) is compromised.
Nuerogenic (nerve related) TOS is the most common (over 90% of patients) and is often the most difficult to diagnose and treat effectively. Patients have burning pain in the shoulder and chest wall area and/or shooting pain (a "pins and needles" sensation) in the arm from the compression of the nerves of the brachial plexus. Pain can severely limit the movement of the arm. Hand weakness can also develop over time.
Venous (vein related) TOS involves compression of the subclavian vein draining the arm. It can produce arm swelling, fullness in the armpit and engorgement or prominence of the superficial veins of the chest and shoulder region. Sometimes compression can cause venous thrombosis (blood clot in the vein) which leads to permanent venous damage.

2- *Arterial (artery related) TOS is the least common type of TOS and involves compression of the subclavian artery which supplies blood to the arm. It most often causes subclavian artery aneurysms, which can result in emboli (blockage of small hand arteries from a blood clot that breaks loose from the aneurysm). Patients may develop numb, cool or blue fingertips. Less commonly, subclavian artery compression results in arm pain or weakness with the use of the arm.* (This is what I had along with nuerogenic see above the arterial problem for me included all of this even the last statement of arm pain & weakness with use of the arm. I also had the venous issue as a side affect of the artery compression see above, as I had the armpit issue & prominence of the veins in the chest towards the latter part. I was very compressed in the words of my surgeon.)

How is Thoracic Outlet Syndrome Diagnosed?

TOS is often suggested by symptoms and physical examination. X-rays can show an anomalous rib or bony abnormality. Nerve testing is sometimes performed to assess nerve damage. Venous TOS is diagnosed by positional venogram. During this exam, contrast is injected through an intravenous line in the arm and used to outline the vein while the arm is moved above the head to maximize compression on the vein. Arterial TOS is diagnosed by angiography. This test involves inserting a catheter into the femoral artery in the groin, guiding this up to the subclavian artery supplying the arm and then injecting contrast to outline this vessel to detect any aneurysm or blockage.

How is Thoracic Outlet Syndrome Treated?

The cornerstone of treatment for neurogenic TOS is specific physical therapy beginning with breathing exercises and attention to posture. Transcutaneous electrical nerve stimulation (TENS) is often helpful. 3- *Surgery may be indicated in severe refractory cases and involve removal of the unusually large scalene (neck) muscles, scar tissue around the nerves, and any bony abnormalities. Although in carefully selected patients the initial surgical outcome is excellent, symptoms return within a year in as many as 25% of patients, presumably because of scarring around the nerves.*
Arterial and venous TOS are usually treated with surgery, which involves removing the scalene muscles and first rib. Often angiographic techniques are employed in conjunction with surgery to dissolve blood clots or angioplasty (stretch) or stent the involved vein or artery. Prognosis is excellent in most cases.
From - http://www.camsf.com/vasc_thoracic_outlet.html

It just figures that I stumbled across this now, rather than sooner this would have helped me out A LOT. IT nailed everything, but also echoes what my surgeon who I said yes too did. It was written very well I thought. I came across this looking for a question I had on recovery
Jill

[Justin]

Jill,

Thanks for posting the information above--it is a great resource. I hope your recovery is going well.