Date: Sun, 21 Aug 1994 13:01:55 PDT From: Steve Hansen Subject: TOS To: Multiple recipients of list SOREHAND X-To: sorehand@ucsfvm.ucsf.edu X-Cc: mmaceri@wpo.borland.com In an effort to treat my TOS (Thoracic Outlet Syndrome), I have visited lots of people in the health profession. Many were of no help, and those who were helpful were evaluating the condition with a particular focus, and thus missed other stuff. I realized this because each professional told me something new about my problem which I didn't know before. I have gotten better at taking the knowledge which makes sense to me and throwing out the stuff which is B.S., i.e. I-don't-know-what-I'm-talking- about-but-the-patient-doesn't-know-it-hee-hee-hee. These are some things I have learned: * TOS, Myofascial Pain Syndrome (MPS), and neck dysfunction often go together. In my case, I have not experienced any trauma in the neck. But I do have two "intersegmental joints" which are stuck, thus restricting movement in those parts of the neck. Often the restriction in movement is so subtle that only a trained person can see it. A joint can be "unstuck" by a chiropractor, osteopath, or by yourself over time with the help of a physical therapist. I have chosen the latter solution. As I have learned, "stuck" joints in the neck are quite common. Stuck joints can result in nerve impingement, and can therefore be serious. * MPS is a painful condition where the muscles become knotted, tight, and hardened. They will usually have a point on them which is the most tender to pressure when applied by the thumb. This point is called a Trigger Point, and may refer pain to other parts in the body. MPS IS THE MOST COMMON REPETITIVE STRESS INJURY. This is controversial. But I am joining the small camp of people who are arguing this. My own experience confirms this. I spent many months in PT centers where so-called "tendonitis" patients were wincing in pain during trigger point therapy. The real absurdity is that the PT's are treating an injury which the M.D.'s have yet to acknowledge even exists! * Here is a real pearl: TOS can produce MPS, MPS can produce TOS, TOS can produce stuck joints, stuck joints can produce TOS. It's this : MPS <--> TOS <--> stuck joints. In other words, these three conditions interact together to create a rotten party that is difficult to stop. Of course the primary factor through all this is constant typing in a static posture. Unfortunately, once the party has really gotten going, changing posture and typing activity won't stop it. For months I have been trying to stretch and relax the scalenes and minor pectoralis muscles, but could not stop the nerve entrapment. Recently I started working on freeing the stuck joints, and I have been able to free one of them. I'm getting positive results. I'm beginning to slow down the party. My theory is that in my case the stuck joint(s) _are_ pinching the nerves in the neck, hence the increase in myofascial pain, muscle tightening, and further pinching of the brachial plexus. I believe that the TOS aggravated the joint problem to begin with, i.e. one nerve entrapment produced another. But I'm optimistic now. * If possible, avoid choosing a medical practitioner solely by his/her title/specialty. I went to a _world renowned_ physiatrist who not only does not believe in TOS, but was not able to tell me about my stuck joints. "The MRI is normal." Instead, follow the recommendations of patients, PT's, etc. Caveat: all of the above is what I _believe_ to be true. Steve Hansen shansen@adobe.com