thoracic outlet syndrome

Heart Attack or Thoracic Outlet Syndrome ?

January 3, 2011 by drburt 2 Comments

Today’s post is about real case that have treated on Friday. I saw this patient over a year ago for severe neck pain and headaches. Patient’s problem was resolved with very good results. This morning patient’s husband calls and asks me to see his wife today as an emergency visit because she has numbness in her left upper extremity, loss of temperature in that extremity, and shooting pain. Over the phone he explained to me what has happened couple of days ago.

He took his wife to a near by Hospital Emergency Room suspecting that she had a heart attack. She had severe shooting pain in her left upper chest and shooting pain down her arm. In a Hospital medical Doctors performed a complete check up, including laboratory test and fancy CT- Scan diagnostic. After numerous hours they found nothing wrong with his wife and discharge her home with some pain medications. She was not very happy with an outcome since the symptoms were still there even with pain medications.

This morning I performed my examination and was trying to figure out what was wrong with this lady. First off all she always carries her heavy bag on her left shoulder with her belongings and belongings for her two young kids. That was a first sign that the problem was mechanical in nature and something was compressing her arteries and nerves. Her intercostal muscles between first and second ribs were extremely painful. Her left clavicle (look at the picture on a left) was out of alignment and did not have any movements during passive and active range of motion. Both of her rhomboid major and rhomboid minor muscles were very sore as well.

My Solution to This Problem:

I have diagnosed this lady with TOS. The first procedure was the electrical stimulation and moist heat. I used electrical stimulation on PAIN and CONSTANT settings for 15 minutes. Two pads were placed on her first and seconds intercostal spaces and two pads were placed around rhomboid major and minor muscles. Moist heat pack was placed in the same area for 15 minutes as well. Next, my massage therapist worked on her tight muscles for about 20 minutes or so. My CMT has informed that her entire left side is completely out of balance. Muscles were tight and patient was guarding during the massage which made her job a bit more difficult. But she got it done. After the massage I have performed full spine Chiropractic Adjustment ( that included cervical, thoracic and lumbar spine) and I have adjusted her first rib and clavicle on the left side.

I have called later on today to follow with this patient. Patient has informed me that she did not feel any pain since I saw her this morning. She has also informed me that she felt wave of heat coming into the left side of her body and left upper extremity.

The moral of this case: – please carry your heavy bags on both shoulders if you have too. Make sure that your kids’ backpacks are not too heavy and they carry them on both shoulders as well. Let’s start 2011 with a healthy habit.

Happy New Year !!!

Post a comment below or share your thoughts through Facebook, Twitter or comment section below to join the conversation. Feel free to add any additional tips.

Thoracic Outlet Syndrome Treatment Techniques – Part 2/3

October 25, 2010 by drburt Leave a Comment

Thoracic Outlet Syndrome treatment techniques

There are different treatment methods available for thoracic outlet syndrome such as exercises, treatment therapy and even surgery. There are other non-conventional treatments available too, such as the Chinese acupuncture.

Chinese acupuncture needles

The Chinese acupuncture technique uses microcurrent device that are polarized at 50 to 75 microamperes, and zimmer pads. It uses point combination in treatment of TOS. PC6, SI3, ST41 and Liv4 are point combinations used.

The treatment takes 4 weeks with 2 to 3 sessions each week. The acupuncturist would insert the acupuncture needles subcutaneously and place stimulation pads (microcurrent) on top of each of the needles.

The polarized acutron mentor pads are applied on top of the needles directly. It has a positive and negative pad; the positive pad’s applied on the scalene muscle insertion (anterior) and the negative pad on the PC6 or the SI3. The electric stimulation usually cannot be felt by the patient as the microcurrent is sub-sensational. Some patients are more sensitive though and they can feel a tingling or vibrating sensation on the area but it’s quite subtle.

After 8 treatments, patients notice some improvement. The pain and burning or tingling sensation is minimized and the patient’s requirement for pain medication is also decreased or even stopped. Daily activities that require strength on the upper extremities are easily performed compared before the patient had the treatment.

With acupuncture therapy, the patient is still required to do some stretching exercises at home. These exercises are targeted on improving and recovery of the scalene muscles and tendons. It should be performed 3 times a day with at least 5 repetitions each time. Posture should also be improved to gain the proper biomechanics of the body.

Home exercises

A treatment plan for thoracic outlet syndrome or TOS requires a home exercise program to increase the speed of recovery. These exercises must be performed carefully and slowly. Each stretch position must be done to a point that you stretch without experiencing pain. Once you feel pain that means it’s too much and the patient must decrease the length of the stretch to a point that it is still painless. As you progress, you can extend the length of the stretch with pain as an indicator of your limit.

Corner stretch, neck stretch, shoulder rolls, thoracic extension, and overhead raise are just some of the home exercises prescribed by the medical professional to be exercised by the patient suffering from TOS.

Chiropractic Approach

Proper treatment of thoracic outlet requires an accurate understanding of the postural factors involved. Most recent treatment programs consider evaluation of joint mobility and muscular imbalance.

Once diagnosis of thoracic outlet syndrome is made by a Doctor of Chiropractic, a specific treatment program is designed for the patient.

More specifically, chiropractic management will focus on joint mobility in the cervical (neck) and thoracic (upper back) regions of the spine. Frequently, patients with thoracic outlet will have joint tightness in these areas which is treated with spinal manipulative therapy, stretching and rehabilitation in the office.

Keep in mind; there are other conditions that may cause similar symptoms. In either case, if you are currently suffering from similar symptoms, be sure to consult your chiropractor.

A chiropractic doctor might also advice you exercise routines and they may even prescribe you with their own exercise programs. Make sure you consult with the doctor before doing any of the home exercises to make sure that what you’re doing is actually going to improve and not worsen your condition.

The home exercises treatment technique combined with a proper treatment therapy from a medical professional is the best way to increase the speed of recovery and to diminish the pain suffered by TOS patients.

If you have any additional information, please write about it in our comment section.

Questions/Answers #1-#5

August 17, 2010 by drburt 6 Comments

#1 Falling asleep on arm numbness?

Lately I have been waking up just about every night with a tingling, numb arm because I have been falling asleep on it. I figure it becomes like this because the circulation is cut off. Can this be potentially dangerous or hint toward something of greater significance and severity?

Answer:

Thank you for visiting and asking a question. Sleeping for a prolonged period of time on your arm will cut-off a blood circulation to your upper extremity. As a result you will experience symptoms such as: tingling, numbness and loss of sensation. Central Nervous System (CNS – Brain) has a unique defense mechanism. When it senses that your body is in danger it will alarm you automatically. In your particular case your CNS sent you a wake up message. This is not dangerous if it happens only because of the sleeping position. You have to try to change sleeping positions and patterns and the problem should go away on its own. However, if you have something like TOS (Thoracic Outlet Syndrome) misaligned Clavicle and even Subluxated Vertebrae in the early stage, the symptoms you experience could be because of these conditions. Please have yourself checked by a local chiropractor when you get chance. Hope you feel better.

#2 My ankle is the size of a softball. Help?

Today at camp I rolled my ankle pretty bad in one of my games. It hurts so bad when I stand on it for even a second :/ What are some tips and pointers you can give me to ensure a speedy recovery? And have you ever sprained an ankle really bad before??? Your help will be greatly appreciated thank you!! 🙂

Answer:

Hello, The severity of your injury depends on how badly you have hurt the soft tissue that supports your ankle. From you description it sounds like it is pretty severe due to the size of the swelling you have described. At this point and time I would use ice – 15 minutes on and 45 minutes off every waking hour. This will help to keep inflammation under control. Pick up your phone and make an appointment with your orthopedist or local chiropractor. Most likely your doctor of choice will have XRAYS done on your ankle and order MRI. XRAY will help to rull out a potential fracture and MRI will help to see how sever is the sprain/strain of your ankle. When diagnosis is established you should start rehabilitation process. Assuming you did not rapture your ligaments or tendons I would recommend the following – PT modalities such as Erchonia Cold Laser PL 5000, Ultrasound, and Electric Muscle Stimulation followed by deep tissue massage from CMT.

If your tendon or ligament has severe tear arthroscopic surgery is inevitable.

#3 I thought I pulled a muscle but….?

A couple of weeks ago I was at the gym as usual running on the treadmill, towards the end of my session, I started to feel a pain which is centered on my left buttock. Since then I have not been able to run at all as it is too painful & sometimes I can feel a discomfort just walking around normal or sitting.
At first I thought i pulled a muscle but since it’s now been two weeks… I think it is probably something else.
Thanks

Answer:

From your description it sounds that you have Sacroilliac Joint (SI) misalignment. When SI joint is subluxated symptoms will get worse upon walking. The reason why pain level goes up is because SI joint plays a very important and active biomechanical role in a walking process.

You can self diagnose if your SI joint is misaligned. Stay in front of the mirror with your eyes closed and march in one place for 5 seconds. When you are done marching open your eyes and look at your – 1) ear level, 2) shoulder level, 3) hip level. If one side of your hip is higher than the other your SI joint is misaligned. An even better way is to have someone else take a digital photo of yourself with your eyes closed. You will be able to see it for yourself how the shoulders and neck compensate for your SI joint problem. I would suggest to see your local D.C. and fix the problem in a couple of sessions.

#4 A Fourth Sprained Ankle?

I sprained my ankle twice in the past year. One time I slid on ice and sprained on side in late February and then in March sprained the other side as well as the first side. During June I wore an ankle stabilizer so I would not injure it again in PE but in July the pain came back and went away in a few days. Now I can’t really walk that great on it. I told my Mom but she says it’s fine. After injuring it in Feb and March I was prescribed physical therapy but it isn’t covered by insurance unless it follows a surgery. Does anyone think I may have injured it for a fourth time??
~~~Sorry for the long description.~~~

Answer:

Most likely you have a flare up of an old injury that has never been properly rehabilitated. Weak ligaments and tendons are very easy to injure again. Post traumatic soft tissue fibrosis makes your soft tissue less elastic. Since you do not have insurance I would suggest to find local CMT get some deep tissue done on your ankle. MRI of your ankle would tell the entire story, but it is very expensive. Also Cold Laser therapy by Erchonia PL 5000 and Ultrasound will be able to get some good results. Those modalities should be available in your local D.C. office.

#5 Should I still work if I have a herniated Disc in my back?

I just had an MRI done and found out not only do i have a disc protrusion in the lumbar section of my lower back, I also have chronic arthritis in my spine and degenerative disc disease. Is it good for me to continue at a job that I have to lift heavy objects repeatedly?

Answer:

Repetitive heavy lifting will accelerate the degeneration of your lumbar disc and osteoarthritis. As a result it will cause more pain and your ability to perform Activities of Daily Living. It would be great if you could find a different place of employment that does not require repetitive lifting. You can also ask your employer to provide a modified duty for you if such is available.