very specific dermatomal patterns with a disc bulge.
In TOS, both the artery and the brachial plexus of nerves are affected.
Could you please tell me Why my primary care physician and any other surgeon I have talk to will not see or look into TOS as a possible problem in my case. I have all the symptoms you mention but none of my visits to the orthopedic surgeon or my primary care physician will even consider this to be my problem. They only want to see this as a disc bulge and apparently this is the majorities view on the subject. Do you have any suggestions for what to do about TOS if it's in needs to be fixed by an operation?
Hello Scott, A disc bulge and TOS are poles apart; of course, it's theoretically possible to have both, but that's most unusual.
Let's consider the symptoms and signs of each.
Firstly a disc bulge in the neck; if it's affecting the arm, the tingling and ache in will be very specifically following a "dermatomal" pattern. In TOS the symptoms are often a lot more vague, because the nerve root, per se, is unaffected.
With a disc bulge, Spurling's sign will be positive; turning to the same side and looking up will give you pain in the lower neck and, in a bad case, immediate radiation to the arm. In TOS this is much less likely to be strongly positive.
With a disc bulge, the Upper Limb Tension Test will be strongly positive. Use the site search function at Chiropractic Help to find it; you could do the test at home. It will be either negative, or only vaguely positive in TOS.
A disc bulge will give very specific weakness in the arm, loss of reflex and numbness.
In a disc bulge, the Shoulder Abduction Relief sign will be positive; again use the site search function. In short, raising your arm above your head will relieve the pain in the arm; in TOS it increases the pain.
And lastly, in TOS Adson's test will be positive; use the search function. But it's a difficult and subject test; in my book the wrist radial pulse needs to greatly diminish or cease completely in the affected position, AND RETURN when your head regains the normal position, and you breathe normally again.
A TOS op is quite risky procedure, done through the arm pit. Mind you a neck op is not without it's risks too.
Have you seen a thorough, experienced chiropractor for an opinion? That's where I'd start before I let the man with the knife near my neck! But neck manipulation is not entirely safe either. So, it's your call. Good luck.
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.
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.
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.
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Issue #47: Life without medication/ Eight coloured foods
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Issue #45: Tingling, weakness and malaise/ vitamin B1
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This site is not intended to diagnose, treat, cure, or manage any illness. Please consult your chiropractor.
The information is to the best of my ability at the time of writing accurate and correct. Queries, comments and corrections are very welcome.