Thoracic Outlet Syndrome

[Mongo]

Gents,

Just starting a thread to see if anyone else has TOS and how it's affected their exercise habits. I've got arterial, venous, and nervous.

At its worse I lose my feeling from shoulders to finger tips. Can't grip the bars, and lose the ability to contract the hands and fingers altogether.

Symptoms get progressively worse with shoulder rotation, which is why I've been out for a couple years. Found a surgeon to help fix the issues. So it's my comeback per se.

I'm always open to hear other medical stories and conditions if anyone else wants to share.

Mongo

 

[Dr JIM]

How was the diagnosis made?

 

[Mongo]

They do a pretty extensive ultrasound of the shoulder girdle where the nerve, artery and vein are. They also hook you up to a heart rate monitor at your finger tips. They get your baseline measurements, then rotate the arm in 3 different positions to see if your radial pulse (wrist) stops, and the ultrasound will show the artery and vein not supplying any blood to the arms.

Once they get all the measurements they compare it to "normal" measurements. But if you are like me and have 0 pulse from any shoulder rotation, it is an easy diagnosis.

Do you have symptoms?

 

[Dr JIM]

Sure OK that helps me understand what I think you mean by having "all THREE, arterial, venous and neurologic".

But your a LONG WAY from surgical intervention based on the diagnostic tests performed to date.

I'll try to explain WHY IF you believe this form of "help' is what your looking for, JUST REPOST TO LET ME KNOW ONE WAY OR THE OTHER.

Regs
jim

 

[Dr JIM]

No doubt I should have mentioned my opinion is/was based on the studies you have said were performed TO DATE.

To that end what you're describing is a single study (a vascular doppler) to diagnose an arterial occlusion, which is complicated by neurologic and presumably venous symptomatology yet supported by provocative maneuvers.

If this is indeed the case, your evaluation is completely inadequate.

Fact is, I would avoid like the plague any surgeon whom is willing to "operate" on a patient with such a confounding diagnosis based on a doppler alone!

Regards
JIM

 

[Mongo]

What other treatment options are available from the studies, they also ran a CT Scan with dye, took thoracic X-rays, tested for compartment pressures in the forearms, tried some nerve entrapment tests.

I've had a second and third opinion from a couple specialists from three different hospitals, Massachusetts General, Walter Reed medical facility, and West Point Keller Army Community Hospital.

They agreed that removal of the first rib would be beneficial to alleviate symptoms. Let me know your thoughts.

 

[Dr JIM]

Well now your story and situation has changed considerably, bc you have actually had an reasonably extensive evaluation and a diagnosis based on same.

It also seems your primary diagnosis is what's referred to as ARTERIAL TOS rather than NEUROLOGICAL or VENOUS TOS.

Now this is VERY important bc your asking mates on a forum what their experiences are or may have been with this condition BUT NOT differentiating the THREE CATEGORIES.


It's very important bc the ARTERIAL form although uncommon carries the BEST prognosis with surgical intervention and while the NEUROLOGIC (Brachial Plexus) is the most common it also responds poorly to surgical intervention.

So while I encourage your efforts to compare notes with others, I would also suggest you confirm which category others may have to ensure your comparing apples to oranges"!

Good luck!
Jim

 

[21p]

lol, you can't diagnose the specific type of TOS on the internet. TOS can affect all three (vein artery nerve), some of both, or just one, contrary to what you're reading above (again, ask yourself, who are you asking for medical advice? How do you really know we know what we're talking about?). I think your vascular surgeons are going to give you the best opinion. Stick with them on this one.

 

[Dr JIM]

DIAGNOSING a condition on the net absent clinical features and appropriate imaging studies is fool hearty but show me where I've done that DUMBASS

What do you believe is the cause of an obliterated radial artery during shoulder movement? Hmm sounds pretty classic to me!

Why Dr JIM the OP is also describing neurovascular symptoms, yep and these are classic features of ARTERIAL TOS which is also WHY he IS being evaluated by a VASCULAR SURGEON, and has had MULTIPLE VASCULAR IMAGING STUDIES (if you know what those are) duh, LOL!

Oh and incidentally TOS are classified according to the PRIMARY ANATOMIC STRUCTURES that are responsible for the patients signs and symptoms, which I also mentioned "above"!

 

[21p]

You are so far out of your league, I'm embarrassed for you. Stick to TRT advice and you'll be better for it.

 

[Dr JIM]

Oh I'M enlightened by your vast fund of knowledge on TOS, SHRINK! That's it! I thought you were going to refute my comments based on TOS evidence based literature, lol)

(May I suggest you use Ladies Home Journal this time around for your rebuttal reference)

 

[21p]

Hahaha, ok man we can take it there. Well first things first. Do you think he wouldn't know what type of TOS he has if he has seen 3 surgeons? Do you also think there are three separate and distinct categories of TOS? I don't. Most doctors who actually see patients don't either. They teach it that way so you can get a framework of what you'll be seeing along the spectrum of TOS patients. His going and looking for people on the net is a bad idea precisely because there are no real categories of TOS!!! There are vascular guys who specialize in this field after 6 years of medical training 14+ hour days. What on god's green earth do you have to offer besides your own personal case of TOS experience?

IF YOU DON'T KNOW, STFU and MOVE ON. I'm not claiming I wrote a book, I'm pointing out the fact that I know enough to know you sure as hell don't know and could possibly harm the guy with the cut and paste shit you're doing here.

 

[Dr JIM]

Hahaha, ok man we can take it there. Well first things first. Do you think he wouldn't know what type of TOS he has if he has seen 3 surgeons? Do you also think there are three separate and distinct categories of TOS? I don't. Most doctors who actually see patients don't either. They teach it that way so you can get a framework of what you'll be seeing along the spectrum of TOS patients. Are you also going to tell us how to take out a rib too?

IF YOU DON'T KNOW, STFU and SIT DOWN. I don't claim to know, I'm just pointing out the fact you sure as hell don't know and could possibly harm the guy with the cut and paste shit you're doing here.

Damn this is about the most ridiculous argument I've heard all month! Even though you readily admit you DON'T know a damn thing about TOS, you somehow contend this absence of knowledge qualifies you to render advice and refute my suggestions!
The classic know nothing naysayer troll!

I mean can you support any of the crap you just spewed? They "teach it that way" bc that's how the ailment is categorized for research purposes and for therapeutic outcome analysis, fool!

Fact is many patients are indeed confused even more so after being evaluated by three surgeons, especially when the diagnosis is as confounding as TOS.

Oh and clown they don't remove the "first rib", but rather only the small "obstructive segment", and if you had half a brain you might understand why!

Finally now that your stupidity has been revealed once again, feel free to highlight ANY of my comments on this topic that "could be possibly harmful"!

Yep CBS was on SPOT YOUR A TROLL for sure!

 

[21p]

No, I'm saying I'm a trained doctor but I don't specialize in vascular surgery. I've stated my case, moving on.

 

[Dr JIM]

Yea and your also FOS!

 

[CensoredBoardsSuck]

Yep CBS was on SPOT YOUR A TROLL for sure!

He's a troll, alright. A young kid, no doubt, and probably still in med school (although that's in doubt) where he's learned just enough to start an argument but not enough to finish one, never mind win. Instead, he stirs the shit and then hides behind obfuscations and ad hominems or refuses to engage because he is unable to construct a rebuttal. Classic troll behavior.

 

[21p]

Whatever you want to believe. This DRJIM guy is not a doctor. If he says he is, he's lying.

 

[Dr JIM]

Any time you want to play MEDICAL JEOPARDY in real time do let me know, LMAO!

 

[21p]

Alright, mr. ER doctor. I stumbled on a few other threads of people questioning your credentials. Apparently I'm not the only one who thinks you're a fraud, DRJIM. I'm going to give you a few questions, let's see what you know.

What is the number one way rule out metabolic coma?

If a patient comes in to your ER with a fever, elevated opening pressure, and double vision, what test would you order to determine the root cause? What would be your three ddx?

If you suspect a hemothorax, what angle of approach will you take when doing this common procedure? How can you tell hemo from pneumo without an x-ray?

If a burn patient has 27% of his body covered in 3rd degree burns, how would you determine the fluid resuscitation? What would you follow your ringer's with and how much would you give in relative proportion to the initial drip?

 

[Dr JIM]

No it's not done that way bc then you will feel compelled to argue over semantics.

For instance in your first question how long has this FEVER been present, was a CT scan done beforehand and define double vision?

What was this patients neuro exam or her GCS IF she has a HX of trauma?

This only works if the questions are multiple choice bc otherwise it become an test if "what am I thinking".


How about you give me ONE cause of a NON-Anion gap metabolic acidosis!

Or

Describe the EKG changes if acute pericarditis?

OR

Which is the FIRST EKG change of an ACUTE AMI?