TOS operable?

very specific dermatomal patterns with a disc bulge.

very specific dermatomal patterns with a disc bulge.


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.

Dr B

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