Just an update on things...
As some of you know, I�ve been struggling with upper extremity issues since December. I was very active then, working out with weights and swimming 4 to 6 days a week. I am back at work full-time, and still chasing an elusive diagnosis:
- Had appointments with my ADR spinal surgeon, PCP, two different orthopedic doctors, a physiatrist; had 2 MRIs, one CT scan, one EMG.
- Done lots of research online and spoke with patients from this board.
- Had/have frequent massage visits, which are expensive but help.
My symptoms have been odd, ranging from:
- Elevated BP at times
- Cold hands at times
- Throat, armpit, scapular pain
- Tight pecs
- Lethargy
Well, I finally think I have it nailed. My most recent visit with the physiatrist was interesting (the EMG was no fun) and the doctor was very helpful. He offered a diagnosis of �regional myofascial pain syndrome,� which may be accurate, but for me, did not pinpoint the cause of the symptoms. As I was leaving, I asked him to look at my throat. He noted that my neck muscles seemed �awfully tight.�
Months ago, I swore I had some type of thoracic outlet syndrome, and I am finally back to that conclusion. I did some telephone research and finally reached some people knowledgeable about TOS at Brigham and Women�s hospital. They will evaluate and treat me in a few weeks from a PT perspective.
My wonderful massage therapist (she�s awesome, Boston folks!) lent me a book that is not only informative, but helped me visualize and validate my problem. Here�s an excerpt from that book that describes the problem:
�The scalene muscles are divided into three sections: anterior, middle, and posterior. They are strongly implicated in thoracic outlet syndrome, carpal tunnel syndrome, and other painful conditions of the neck, shoulder and arm. This is because the brachial plexus (a bundle of nerves) and subclavian artery pass between the anterior and middle scalenes and may become entrapped if the muscles are hypertonic.� � Facilitated Stretching, Second Edition. Assisted and unassisted PNF stretching made easy.
Here�s what�s amazing. I�ve been doing several different neck stretches daily, and most of my symptoms are gone. My energy is back up, my neuromuscular symptoms are almost gone. So I hope I am on the right track, and this small amount of progress seems to indicate that these issues are not caused by cervical structures (I hope).
I happened to have recently contacted Clair Davies, an author of a very helpful
book about trigger points (also mentioned by Paul in another recent thread) who commented about TOS. Clair, I hope you don�t mind me excerpting part of your encouraging advice:
"...However, if you're able to employ the information in my book you should have no difficulty self-treating thoracic outlet syndrome. The scalenes are key, however, and not everyone succeeds in finding the anterior scalene. You might try calling massage therapists in your area and asking whether they're are using my book. If you need help in finding the muscles, a really good massage therapist is the right one to go to. There are gifted trigger point therapists everywhere. It's just a matter of beating the bushes. Sometimes they called themselves neuromuscular therapists."
So, the �hands on� approach has really helped me through this latest journey. Thanks to Dr. Martinez, one of the few doctors who actually put his hands on me for an evaluation � and offering a conclusion that got me thinking about stretching. And thanks to Catherine, an excellent massage therapist, who helps heal me and offered a very useful book! And thank you to my patient wife, who has been massaging my SCM/scalenes nightly! Jeez, it really does take a village�
PS: Here's a very helpful
reference and web site for scalene massage, written by Clair Davies.