Thoracic Outlet Imaging

Hello, Can you tell me whether there is any way to do any imaging studies for thoracic outlet while sitting up?

I fell last Aug on outstretched arms and something is now causing my jugular to bulge like it will burst whenever I pull back on the shoulder or try to raise my arm.

But I have a frozen shoulder so unable to do the MRI test where the arm is raised, to diagnose TOS.

The veins in my right arm are also swollen, but go down when I am cold, lay down, or raise the arm some.

Since the arm veins go down when laying down, an ultra sound shows no compression anywhere. I am at a loss as what to do next and so are conventional doctors. Physical Therapy is not helping much so I'm thinking of trying a chiropractor but don't know what more can be done.

I have a clunking when swallowing so I'm thinking that a muscle or something may be causing a problem in the neck as your image illustrates. But the muscles in the arm chest area are very tight, so the problem could be there too. Can you give me some direction as to whether there is anything that can be done please? This is getting progressively worse and I would like to find a solution before clots develop.

Thanks in advance!!

Penny

Hello Penny,
Obviously you have a difficult problem and I don't want to suggest there is any easy chiropractic solution. I doubt there is.

Firstly, the fact that the swelling goes down when you RAISE your arm confirms that this may be a thoracic outlet syndrome. But... the vein from the arm doesn't pass through the thoracic outlet usually.

In practice, I almost always find that a frozen shoulder is associated with a first rib fixation, also the cause of many thoracic outlet syndrome cases.

There are new fancy MRI studies that can be done standing or sitting. Shop around.

Have you ever heard, or has anyone done the Adson's test on you. Use the SiteSearch function at Chiropractic Help. It involves testing the pulse in your wrist whilst turning the head and looking up, and taking a deep breath. It's the basic test for a TOS. Hard to do, and quite subjective.

I have no easy answers. Working on the first rib, the scalene muscles, the frozen shoulder and that midthoracic pain is where I would start.

Other health issues? High blood pressure, obese, diabetes? Smoker?

I'm not sure this contributes, but good luck anyway.

Dr B

Comments for Thoracic Outlet Imaging

Average Rating starstarstarstarstar

Click here to add your own comments

Feb 23, 2013
Rating
starstarstarstarstar
Re: Thoracic Outlet Imaging - Thank You
by: Penny

Thank you so much for your fast and helpful reply!! I will start looking around to find where I can go for this imaging.  You mentioned that a frozen shoulder is associated with a first rib fixation?  Is it possible that the fixation of the first rib will go back to normal when my frozen shoulder resolves? The veins began protruding in the arm at the same time that I started losing range of motion, so I am hoping that blood vessel constriction will resolve when my frozen shoulder resolves.  But from what I have read, that does not sound likely.   I was also told that I have a partial tear in the rotator cuff, so I don't know whether that factors in. 

Another thing that could be causing problems is that it feels like the muscles around the shoulder area are shortening and tightening.   When using the arm, the pulling feeling extends into the neck, back and chest area.  Massage helps loosen them, temporarily, but the blood vessels continue to protrude.   

Otherwise,  my health is good.  I've never smoked, not overweight, blood pressure has always been low 110/70 (but is now higher,  140/90, probably due to the stress of seeing the bulging jugular).  The  stress seemed to be making the muscles even tighter, so my doctor gave me something to relax.  That seems to temporarily help loosen the muscles, but has no affect on the venous constriction.   They  did perform a test where they felt my pulse while I moved in various ways  (I assume this was an Adson's test) but a pulse was still felt in the wrist.  They don't know what to do with me, so I am really hoping that I will be able to find someplace that has one of the newer MRI's to help locate the source of the constriction.  Thanks again for all your help!

It's great that your general health is good, Penny. That's a big plus.

Your situation needs both medical and chiropractic care. What's still not clear is the cause of the vascular constriction, and that needs to be clarified. I take it you've been to a vascular surgeon.

The subclavian vein does occasionally as a normal variant pass through the inter scalene triangle, but it is the exception.

You can be sure that this tightness in the chest and neck, the frozen shoulder, the rotator cuff tear and the swollen veins are all connected.

At C-H you'll find some "frozen shoulder exercises". Use the SiteSearch function and start doing them daily. Start slowly.

Look for an experienced chiropractor in your area who has experience in dealing with frozen shoulders. Sorry I'm not nearer...!

Dr B

Click here to add your own comments

Join in and write your own page! It's easy to do. How? Simply click here to return to Chiropractic help Questions (General).


Did you find this page useful? Then perhaps forward it to a suffering friend. Better still, Tweet or Face Book it.


Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.



Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?


Interesting questions from visitors

CLS writes:

Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

Your own unresolved problem. Pose a question

Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.


You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.

The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.