Thoracic Outlet Syndrome

[lisa]

My Orthopedist and Neurologist think I have Thoracic Outlet Syndrome.  I know this is very difficult to diagnose and is often misdiagnosed with surgery being performed unnecessarily.  I do have the cervical rib and lose the pulse when the arm is raised.  I've had an EMG but I am now being told that it was done incorrectly so another will be done tomorrow.  Is there any other way of diagnosing this?  I have a lot of shoulder and neck pain as well as tingling in the hand and fingers, especially when the arm is raised at all.  The neurologist says that if I did need surgery there are only four places in the US that he would send his patient.  He only mentioned two, which were LSU and The Cleveland Clinic.  If I'm told I have TOS I want it proven to me that I really do have it!  Is there a test that will definitely show it?  

Thank you very much.

[CCF Neuro[P] MD, RPS]

Dear Lisa:

Yes, you are very correct in that TOS is very rare and often over-diagnosed.  The subtypes of compression of the subclavian vein causes dusky discoloraton of the arm, venous distention and edema.  Compression of the subclavian artery results in ischemia of the limb, possible gangrene.  There can be lesser forms with Raynauds phenomenon, brittle nails, and ulceration of the fingertips.  I am assuming that these are not what you have.  Thus, the EMG will be the most diagnostic of the tests.  Nerve conduction studies disclose a reduced amplitude of the ulnar sensory potentials.  There may be a decrease in amplitude of the median motor evoked, a mmild but uniform slowing of the median motor conduction velocity, and a prolongation of the F-wave latency.  Concentric needle examination of the affected hand muscles reveals large-amplitude motor units, suggesting collateral reinnervation.  You should have slight wasting and weakness of the hypothenar, interosseous, adductor policis and deep flexor muscles of the fourth and fifth digits.  Without these findings you likely do not have TOS.  Wait for the EMG findings and then proceed.  Just because it is rare, doesnot mean that you do not have TOS.  Besides those mentioned, the Mayo clinic is a good place.

Sincerely,

CCF Neuro MD

[JEANIE]

Do you think a Chiropractor can help me for a pinched nerve in my shoulder?  

She is helping me for a back injury which occured October 11.  I had muscle spasms, inflamation and my pelvic and neck area was out of line from a fall.

Now the pinched nerve has subsided in my upper back but seems to have traveled in my right shoulder going through my neck to my jaw to the ear.

Should I tell my Chiropractor or give my MD a call?  

[CCF Neuro[P] MD, RPS]

Dear Jeanne:

I have no opinion in the matter.  

CCF Neuro MD

[CCF Neuro[P] MD, RPS]

Dear Lisa:

I would get a second opinion.  Without EMG confirmation, there is no TOS.

Sincerely,

CCF Neuro MD

[lisa]

My neurologist and orthopedist both say that I have TOS, even with the negative EMG.  They say that it only means that it's not an advanced enough case to have damaged the nerves.  I don't know what to do!

[CCF Neuro[P] MD, RPS]

Dear Lisa:

The EMG makes the diagnosis.  If the EMG is negative then you likely do not have TOS.  

CCF Neuro MD

[lisa]

I have another question.  The EMG was normal and the neurologist says he still thinks I have TOS.  I'm not convinced.  The orthopedist thinks it could be that or my neck.  I have a bulging disc in my neck and bone spurs.  I need to know which it is for sure!  I can't stand the seat belt across my shoulder or my bra strap anymore!  I've started getting headaches, which is something I've never really had before.  What do you think?