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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