Possible TOS?

by Maria
(Tampa Florida)

Possible TOS?

Until recently I have never had to ride a bus, but I did recently because of car trouble and I got hurt. I wrongly assumed the driver of the bus was passing my stop, so I stood up to ask him a question, I had to grab hold of a pole with my left arm because he slowed down and turned a corner, and even though I was grabbing the pole with my left arm, I got swung around, and my upper left arm also got squashed a little between the pole and my rib cage. I was trying to use my arm as a barrier so my ribs would not hit the pole. It was like a whiplash injury. A few days later I had intermittent swelling in my left arm and neck, and intermittent chest pain. I went to the ER and they did a Chest XR to see if I had a blockage in my Vena Cava and it was negative. I completely forgot to tell them about the incident on the bus.

I called my chiro and he gave me some neck exercises. Then when I kept getting the swelling in my arm, neck, face, and even my body cavity, I contacted him again, and he told me to go to my ARNP.

I do not have insurance and I go to a sliding scale clinic. So I followed up with the ARNP, and she tested my range of motion and did a special series of tests by pressing my arms and shoulders and spinal area. I have a pain in my cervical vertebrae.

I have had a pinched nerve in my cervical area before and chiropractic fixed it but my chiro is being cautious. The ARNP also ordered XRays of my cervical, thoracic, and lumbar spine as well as a left shoulder series XR. I got better and put off the xrays but for the past week I have not been able to sleep comfortably and I had a 3rd bout of milder swelling again yesterday. It has been a month and a half since the bus accident and the 2 earlier bouts of swelling; a week later, and now again a month later. I have had pain that comes and goes in my armpit and numbness that travels in my entire back.

My ARNP at a community health center ordered the xrays, but my chiropractor does not seem to want to take the case until he sees the xrays. He refused to see me for an adjustment a month ago when I reported the 2nd bout of swelling. Now he will not see me until he sees my xrays, and even then he might refuse me. What further tests do I need to do to find out if I have TOS? CT or MRI?

Also, should I be doing special exercises. Sitting at the computer aggravates the back of my neck with a pinched feeling. Cervical exercises help a little, but some of the shoulder exercises my ARNP gave me seem to aggravate the situation.

Hello Maria,
Reading this, am I correct that you've only spoken to your chiropractor on the phone? He's right to be cautious, but what I think is that a thorough chiropractic examination, without treatment, is called for.

What's really not clear is whether the pain in your arm is from a bruise on the shoulder or ribcage, a glenohumeral injury, a pinched nerve in the neck, a rotator cuff syndrome, or indeed a disturbed blood supply to or from the arm. He needs to examine you, in my book. If he won't, find a local chiropractor who will.

Adson's test is done to confirm a TOS but it's a difficult and subject test unless done regularly by the examiner.

Perhaps print this out and fax it to your chiropractor and see what his response is. Let me know what transpires.

One more thing to consider; does raising your arm above your head, to the side and behind your back cause pain? Or using it to brush your hair for example, does it cause pain?

Dr B

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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.

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