TOS and the Elbow (Ulnar Nerve)

[Jacobba]

I had successful TOS surgery 2 years ago, recently went back to work; however, I'm noticing a significiant increase in pain in my forearm and elbow area. These are some of the pain symptoms I had prior to surgery. My keyboard/typing is actually much less in this working environment than when I was not yet back to work - so, I'm not suspect of the keyboard action causing the pain. What I am suspect of is the increased contact with my elbow/ulnar nerve on my desk or ergo chair. Has anybody had any similar experiences? Any feedback?
Thanks.

[demay]

I have just had my appointment for the final results, and I have a trapped ulnar nerve and the speicalist thinks that is what is causing my tos. I have also a cervical rib on each side but he is insistent that the trapped nerve on my elbow is causing TOS. So wait now for surgery date (5 months from now) and see what releif I get then....I will not hold my breath though

Marie

[DiMarie]

Also, then he pressed on the ulnar in the elbow area and did it travel to the hand down, or upper arm.

I have to find one of my old post to be sure on the inturperation though.
I think if it went to the shoulder traveled to the hand TOS, if the elbow to the hand Ulnar....and if up to the face it was tos

But if a bad case then you will have symptoms and tingling, burning everywhere there is a hinge area. The nerve is three feet long and travels to the finger tips from the cervical spine, so even if opened at the thoracic outlet with a rib resection, the elbow puts presssue and wrist on sick, inflamed nerves. Just doing the TOS may reduce, not reverse other arm hand pains.

My daughters' ulnar nerve is so inflamed from her TOS injury that it shows on a regualr xray. The elbow joint is inflamed from this.

Dianne

[DiMarie]

Originally Posted by demay

I have just had my appointment for the final results, and I have a trapped ulnar nerve and the speicalist thinks that is what is causing my tos. I have also a cervical rib on each side but he is insistent that the trapped nerve on my elbow is causing TOS. So wait now for surgery date (5 months from now) and see what releif I get then....I will not hold my breath though

Marie

Hi Marie, If it were me I would have a second opinion to the ulnar nerve surgery. Some doctors will do this as they feel enough release will reduce symptoms enough then thae larger TOS, rib resection for the c-ribs.

My Uncle with TOS, unknown if he has cervical ribs digax to me, had the less invasive ulnar release and had a bit of releif, but he is still limited and disabled with TOS pain.

The ulnar release moves the nerve from the normal route to a shorter one. After all these years with TOS and meeting so many folks with it, it can be a long recovery for a little help.
That is without a diagx of c-ribs. I know we generally have to trust the doctors, and in your case perhaps the surgery for TOS is too much or complicated not knowing the particulars, but I would have a second opinion.

The thoracic outlet is a tiny space behind the collar bone in front of the first rib, the major neurological and vascular bundles pass through here; if you have c-ribs, then that space is even more resticted. It is pressing on the nerves that travel to the fingers.


http://www.ama-assn.org/ama1/pub/upl...lex_how_to.pdf







Thoracic Outlet Syndrome
Causes Symptoms Treatment

What is Thoracic Outlet Syndrome?
Thoracic outlet syndrome (TOS) results from a compression of the nerves that pass into the arms from the neck (brachial plexus). The corridor through the area between the neck and the armpit (thoracic outlet) is narrowed causing the compression. This compression causes pain in the shoulder, arm or hand or some combination of the three.

This condition is difficult to diagnose and many times, the doctor will need to rule out other conditions before making a diagnosis.

Causes of Thoracic Outlet Syndrome?
In many cases, no specific cause of TOS is found. However, any other condition, which results in growth or movement of the tissues near the thoracic outlet, can cause the syndrome to form. Examples of other conditions includes:


Muscle enlargement
Injuries to the area
Extra rib from the neck at birth (cervical rib)
Large callus from a healed clavicle fracture in an adult
Tumors at the upper part of the lung
Poor posture, especially in women with large breasts

An injury to the thoracic area may cause scar tissue to develop during the healing process. This scar tissue may lead to a compression of the nerves and blood vessels. Repetitive activities can also cause compression, especially activities that put the arms overhead. Slouching and dropping the shoulders is thought to be a common cause. This movement leads to tension in the muscles at the side of the neck and can constrict the nerves and arteries of the thoracic outlet.

Symptoms of Thoracic Outlet Syndrome?
The most common symptoms of TOS are:


Neck, shoulder, arm and hand pain
Poor circulation to the extremities
Weakness, numbness and fatigue in the arm and hand

The symptoms of TOS can appear to be other conditions, making it difficult to diagnose. Herniated disks in the neck, carpal tunnel syndrome and bursitis of the shoulder all have similar symptoms.

In order to correctly diagnose the condition, electrical tests of the nerves in the arm may be ordered by your doctor. These tests will attempt to determine where and how the nerves in your arm are being squeezed. There are other tests used to determine whether or not the blood vessels are also being squeezed. Your doctor may also perform an x-ray of your chest to determine if there is an extra cervical rib causing the symptoms.


http://intraspec.ca/tos.php#Definition
We do have a list of doctors if you PM me to the area you are at, I can perhaps send you those.
Dianne

[demay]

Here in the UK, I am told, that we have a limited number of surgeons that speicalise in removal of cervical ribs, there is only 4 in the country, So very difficult to get a second opinion. I will go ahead with the advise he as given me for the time being about freeing the nerve in the elbow and hope this may eliveate some of the pain, I dont have that much faith in this op. but as they say he is the expert. I was refered to this consultant when the other found I had the cervical ribs, but this one as never even looked at my neck, his answer to the question why is my shoulder lobsided that my left shoulder is in spasm. He as offered physio as well but I have already had five months of that. I guess in time it may all work its self out. Thankyou all for your posts and I am glad every understands the pain and the frustration I am going through

[sandy05]

Hi

I'd just like to say I have had the rib resection (with no cervical ribs). It was almost the last thing they cut-radial, cubital, and tennis elbow were done first on the same side as TOS.I have had carpal tunnel now-six months after the rib resection-(I had neurogenic and vascular TOS)-the pain was almost unbearable right before they did the TOS surgery. Even though I had already had the ulnar nerve released,which is referred to as cubital tunnel, previously it wasn't until after the first rib was removed that I regained feeling in my ring and pinky fingers on the left side. I'm now in PT for the CT and having some problems on the right shoulder now.....I was already diagnosed with TOS on both sides but the left side was my doiminant side and the one most affected. I don't want to scare you off the rib resection cause I do think it was a success in my case. Just don't let any doctor in Oklahoma do it!!!!!Pain following sugery was the worst I had ever experienced.

[Bi-Coastal1]

My Rhuematologist performed a simple diagnostic test. I had bad Carpal Tunnel problems (with bi-lateral arterial & neurogenic TOS).

The Dr. first gave me an injection of cortisone in the wrist...no improvement. Two weeks later, he gave me an injection of cortisone in the thoracic area...poof no carpal tunnel pain for several weeks.

This is an easy, straightforward, logical test and could save you from needless surgery and additional nerve problems.

Try to see if you can have this done. The results are definitive.

Also, from what I have surmised (over the last 9 years with TOS), is that removal of cervical ribs tends to be the most successful TOS surgery, with the best FULL recovery rate. In this respect, count yourself 'lucky'.

Please don't have surgery on anywhere on your arm without this simple test of exclusion.

Best of luck,
Anne

[harry24@ntlworld.com]

I had the operation on my ulna nerve just less than one year ago. After the operation I immediately noticed a pronounced stiffness in my elbow and shoulder when waking from a nights sleep. After excersing for some time my arm and elbow became usable. Since then, mainly due to excercising, the massive stiffness has gone to be replaced by just stiffiness which after moving and exercise enables me to move my arm. Sometimes I have to do the exercise in the night when the pain awakes me. I have, since the operation, experienced a lot of pain in my arm, shoulder and elbow and even though I use Voltarel emulgel on it, it just barely relievs the pain. I am also on Morphine Sulphate for another problem I have and this medication doesn't relieve ihe pain in my arm either.
I wonder if anyone else has experienced these symptoms because when I saw the consultant after my operation he said that it was nothing to do with the procedure.
I didn't have this before the operation though.
I hope someone can help with this problem.