The Upper extremity institute was this Scott Fried? I wonder as he generally is tops to relate why the pain goes from the should, trap to the figer tips.
Originally Posted by Babsie
Hey, my first post, but i really need some answers, or some helpful hints.
The story goes as: August tenth 2009 i hurt my shoulder at work, silly me i waited two weeks to go see the doctor about it. When i finally did, i had hardly any range in my rotary cuff. so i have been going to physiotherapy since september 28th, my range is some what fully back, amongst physio there is aquatic therapy that i have been doing.
just the last month or so i have been having some pinched nerve issues so the therapist sent me to a upper extremity clinic to see what they had to say. and i have nerve issues in c8-t1 area. and anyways they say that my rotary cuff has a lil tear in the tendon, nothing to worry about it will heal in time, tendonitis in my elbow which the swelling has caused some pinched nerves there , down to my pinky and ring finger. and in his words " As a sugeon i have no clue why your shoulder blade is having pinched nerve and pain issues, that is not in my field" so now off to another doctor soon. they mentioned trigger point injections, i read up on them, but is it always a on going thing, or will it end, i mean if i have to keep going then is it really working?
Im just confused, this has been going on so long, therapy every day of the week, everything is driving me crazy. work is really dissapointed in my present status. i need this to be over soon.
so any ideas at all on how to cope with all this and what i should really do, will be appreciated
The cerivical nerve are part of the Brachial Plexus, bundle. The nerves leave the C-4-5-6-7-8 T-1; they travel behind the collar bone, in front of the first rib= the thoracic outlet.
From there they go through the shoulder, elbow, wrist to the finger tips about 3 ft long. When nevers are damaged they do not regenerate in to new nerve cells. The injured cells will die or create adhisions'/scar tissue.
This tissue attaches to anything in the are including the nerves. It becomes entangled and traps. Everywhere there is a hinge joint like the elbow, wrist etc. it compresses and escalates the pain from compression.
While some surgical procedures can reduce the pain and clean up scar tissue and entrapment, it seems to be a cycle of more attaching.
The neck has bands that support the head to collar bone, almost 1/2 of society has short bands...if there is a long neck or predisposition to these short bands, a strecth or injury to those muscles and nerves flare.
My injury was in 2000, I threw myself in a twisting injury from an oncoming car as I was half in half our of my police vehicle. BUT I was not new to TOS, it affected my family for many years before. I was just shocked how a movement could cause my injury. I herniated disc on the left side, but the TOS symptons affected me most severe on the right, the stretch injury side.
I retired from law enforcement, I think that is what helped keep my pain level almost bareable. I did not do more damage. Except what everyday life does.
I had to motify, stop a lot of activities, and become sedintary in my work.
I went back to college pt time, attained my private invest license and do invest for fraud...often fires. accidents, taking witness statements, and supervising childrens court ordered visits with their parents that are estranged or criminals.
It certainly takes its toll. But I need the income. I am on soc sec, and supplement with my as need work. I need my hot tub. valium for spasms, oxycodone for pain, tens that has a massaging effect, not the bee sting type.
I use a tennis ball to a wall and rub loose some spasms. If I can manage the spsams as best I can, I manage the nerve pain. I did have some Trigger points, but the doctor was upset as there is not one trigger....I am all triggers, so we do the most tender
This is where the nerve inserts into the muscle and the muscle detects the inflamed nerve and splints it to protect. That creats a spasm.
Biofreeze every day, and I take 2 baby asprins,
The bursitis flares from the over use. Lately the shoulders and elbows are not the worst, it is the right hip, and low back. I did have sacro-illiac and hip epidural injections.
I believe this is from the sitting traveling to claims, oh like taking truck drivers to have chemical testing after accidents per their insurance carrier.
We have postural changes with TOS the carry of the upper shoulders and chest tilt. to accomadate the hip. tips....
I found that flares help with a dose of prednisone....
My PT, I did NOT do everyday. I did massage, range of motion and heated pool therapy.
My drive is the need to provide for my family, keeping my mind busy from the loss of my daughter.
I home school, cyber school my youngest dd, she has severe depression, anxiety'/panic and agoraphobic since her sister passed away.
My son has depression and seizure/cardia issues that he lost his jobs each time he had seizures.
My older son has several issues including a tear of the rotator that he was nearly detached from the cuff and twice now they tried to repair. This is the opposite arm to his injury from unloading luggage from aircraft. On top of that we have to monitor a pituatary tumor in his brain,
Life is about coping, not even making lemondae from lemons anymore for me, it is sucking up the sour lemons and get through today because I have people depending on me.
I lost my dream job, but I recreated myself using what assests I have.
The one project I worked on was an after school program for Tweens. I signed an agreement for the free use of a space for the fall last week.
Now it is about getting grants and volunteers in this economy.
I never could do it without support....I knew I could not battle this myself, I have my long time friends that are loving and supportive from the forum, my family, and professional network well informed.
Right down to the chiropracter that does not crack my neck, but a heat, tens massage that is to die for to loosen the knots, and belief and knows TOS.
It is not easy, I cry everyday. but I only allow myself the few minutes......
I miss my dd sooooo much, that will never go away, and the change in my life is the rest of my life, that will not heal.
I have choices and am blessed not to be in a stage of TOS that I am devestated.
Creat a list of what you can do....like to do, want to do....and the health, what pain is the worst,
If the shoulder is real bad, it may be the nerve compression pain, treat that, it may not be the tear, but the injuries associated with the tear.
I hope worl has you on Workers comp for this, they can not force you to have surgery if the surgeon thinks the tear is minor and not the issue. Now find a doctor that treats the nerve damage.
Let me know if that was Scott Fried you saw at the upper extremity imstitute,
You are in a good group of supppotive friends with tons of information here,
Welcome and hope we can help!
Thoracic Outlet Syndrome
eMedicine, WebMD (Updated: 1.07.09)
Benjamin M Sucher, DO, FAAPMR, FAOCPMR,
Medical Director, EMG Labs of AARA (Arizona Arthritis & Rheumatology Associates)
Thoracic outlet syndrome (TOS) is a controversial topic in the literature; many proponents support the existence of the condition, but some strongly vocal opponents doubt the validity of TOS as a medical entity. Even the name itself has been questioned because the actual site of pathology is technically the thoracic "inlet," not the "outlet." The primary controversy seems to center around the lack of objective criteria for diagnosis and the confusion with multiple types or clinical presentations.
Since TOS involves proximal neurovascular structures (see image below and Image 1), symptoms often are confused with various distal compression neuropathies or cervical radiculopathies. In addition, surgical treatment has been known to have devastating complications, which further fuels debate with the opponents of recognition of this entity. Conservative treatment appears to be the most universally accepted approach, with even surgeons recommending a prolonged trial before any operative procedure.
Image Credit: eMedicine, Thoracic Outlet Syndrome, BM Sucher, drawing by Travis
Progressive postural decompensation with neurovascular compression.
A.Normal resting posture.
B.Shoulder protraction beginning; the sternomastoid muscles are shortening, drawing the head anteriorly and inferiorly.
C.Advanced deformity with adaptive shortening of scalene and pectoralis minor muscles.
Also note narrowed costoclavicular space (ribs 1-5 have been relatively elevated). Neurovascular compression is evident at all 3 sites.
Thoracic outlet syndrome (TOS) involves compression, injury, or irritation to the neurovascular structures at the root of the neck or upper thoracic region, bounded by the anterior and middle scalenes; between the clavicle and first rib (with possible enlargement/hypertrophy of the subclavius); or beneath the pectoralis minor muscle. Some authors define the thoracic outlet as an opening bordered by the first rib laterally, the vertebral column medially, and the claviculomanubrial complex anteriorly. The syndrome of compression at this site could be primarily neurologic, involving the brachial plexus, most often the lower trunk or medial cord; alternatively, it could involve compression of the subclavian artery and/or vein.
One proposed classification system has broken TOS into the following 3 categories:
•True neurogenic TOS: The brachial plexus is injured in these cases as documented by electromyography (EMG) and/or nerve conduction studies.
•True vascular TOS: The subclavian artery and/or vein is damaged or thrombosed, as documented by arteriogram or venogram.1,2
•Nonspecific or disputed TOS: Patients have symptoms, but there are no abnormal tests to document the lesion clearly. This category is by far the most common type of TOS seen in the clinical setting.
Many authors have discovered accessory cervical ribs associated with TOS3; however, they have noted tough fibrous bands coming off the accessory ribs that are believed to be more responsible for the pathology. There have even been reports of bony fusion of variant cervical ribs, resulting in bifid ribs with attached fibrous bands.4 The bands cause tethering of the brachial plexus, which results in traction and, therefore, symptoms. Other authors report compression or irritation of the neurovascular bundle more distally under the pectoralis minor muscle or from anterior displacement of the humeral head.
Additionally, clavicle fractures can result in plexopathy from expanding hematomas or pseudoaneurysms that compress the plexus, with variable latent periods following the fracture. Delayed onset of symptoms may suggest exuberant callus from the healing fracture site. Nonunion of the fracture site also can result in direct compression by the lateral fragment, which is pulled inferiorly.
Trapezius weakness due to spinal accessory nerve injury (following cervical lymph node biopsy) also has been implicated as a cause of TOS. This results in "droopy shoulder" with secondary compression of the neurovascular bundle, which is particularly aggravated with arm elevation (abduction).5
• Overview • Differential Diagnoses & Workup • Treatment & Medication • Follow-up • Multimedia
1.de Leon RA, Chang DC, Hassoun HT, et al. Multiple treatment algorithms for successful outcomes in venous thoracic outlet syndrome.
Surgery. May 2009;145(5):500-7. [Medline].
2.Davidovic LB, Koncar IB, Pejkic SD, et al. Arterial complications of thoracic outlet syndrome.
Am Surg. Mar 2009;75(3):235-9. [Medline].
3.Brewin J, Hill M, Ellis H. The prevalence of cervical ribs in a London population.
Clin Anat. Apr 2009;22(3):331-6. [Medline].
4.Cagli K, Ozcakar L, Beyazit M, et al. Thoracic outlet syndrome in an adolescent with bilateral bifid ribs.
Clin Anat. Sep 2006;19(6):558-60. [Medline].
5.Al-Shekhlee A, Katirji B. Spinal accessory neuropathy, droopy shoulder, and thoracic outlet syndrome.
Muscle Nerve. Sep 2003;28(3):383-5. [Medline].
Copied this from a informational sheet he gave patients.
It was nice of Dr.T to call today, just wanted to chat he was thinking of me.
Plan For Self Management
Thoracic Outlet Syndrome, neurogenic, can be a chronic illness with significant impact on daily living, work, and interpersonal relationships.
Most people with Thoracic Outlet Syndrome are depressed, miserable and misunderstood. Rightly so. Your lives have been changed and you do not like it.
Few people will understand what you are going through-appreciate your distress you are experiencing. And it is hard to communicate with them. They may be your spouse, your "best friends."
You can help yourself. You may be the only one that can help your self. By taking charge of your illness you can and will modify your illness and the distresses you experience. Thus you will be able to participate more in life.
You can help yourself through it:
If you can keep a diary of every day experiences, particularly the ones that cause more pain you can learn more about your illness and go further to modify what you do and how you do it.
The how is frequently more important than what you do.
TOS General Principles for self-care.
1) Have a plan for each day. It sounds like you have to be very organized....It helps.
2) Do what you can reasonably do. Do Not Overdo.
Err on the side of Less than More...Succeed comfortably.
3) Pace Yourself. Do in small time frames. If the activity takes 30 minutes break it up with small periods of rest.
4) Listen to your body. Do not push yourself. Guide yourself.
5) Be wary of using your arms for long periods of time much above lap level, push-pull or lifting. This may cause more pain.
6) Be wary of using your arms repetitively. Again succeed in comfort not pain.
1) Walking; support arms in a coat pocket, belt, with a sling or shoulder harness.
2) Sitting; support arm(s) with a pillow, coat or cushion etc.
3) Driving; Keep arms low on the wheel, Support arms with pillows.
4) Driving long distances; Break it up into segments of 30 minutes, Stretch, change positions.
5) Phone; use a speakerphone or headset. Do not hold the phone in your hand.
6) Reach; avoid reaching for objects use a step stool. Bring things down to your level what you frequently use that is above shoulder level.
7) Reading; Prop, do not hold the book. Try to keep your head in a neutral position. Do not read in bed.
8) Television; Sit in a comfortable chair, not in bed.
9) For women; If you have heavy breast support them with a corset from below or a good supporting bra. The corset will keep the bra straps off your shoulders.
10) Purse; Do not carry a heavy purse, use a fanny pack.
11) Computer; Needs to be ergonomically efficient. Keyboard in lap and screen at eye level. Change positions frequently.
12) Relaxation; Break up activities (Pace) with periods of no work. Support your arms, Dream, meditate, Rest. All needed to decrease stress and work load on the traps.
13) Posture; Do activities with good posture.
14) Heat; Use heat of ice which ever works best, frequently. Start and end the day with hot baths.
15) Think first; Try not to be impulsive. Remember there are green light, Red light and Yellow-light activities. Know which one you will be doing.
16) Walking; Include walking in your schedule at least three times a week. This is your time to relax, change your perspective and forget about your illness. If done on a routine basis it can reduce the total distress you are experiencing.
17) Good Days and Bad Days; You will have them. Do not try to accomplish everything you have to do on a good day.
18) Work at it; You will have to work at it, it will not come easy. It is a change from the way you use to do it.
Dr. Allen Togut