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Baggy

Almost 3 years of inpingement-like pain

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Hi @Kjetil1234 thanks for your note on my other thread.

Basically developed an injury in Feb 14. Nothing specific triggered it, perhaps a kettle bells class but nothing actually "went"

for year I would get a pec minor type injury if pushing flys too hard. if I rested for 6 weeks it would go. this was the same injury feeling but has never gone. Its a sharp pain around pec minor area and over these 3 years I've seen so many specialists, luckily covered by BUPA at work.

chest specialist, shoulder specialist, rheumatoid specialist, 2 more shoulder specialists, 3 sports physios and 1 osteo!

I've had 3 mris, 3 cortisones, one arthroscopy, bone scan, x ray, ct scan, acupuncture, deep massage, trigger point therapy, and this procedure into my chest where they heat up an inection needle while its inside you to burn off the pain receptors..... none has worked and no scans have shown any injury!!!

I have been put on prednisone - which actually worked over 4 weeks the first time, but then a longer course 12 months ago did nothing. plus gabapentin which perhaps dulled the pain 10% - I have since weaned off all of these meds.

so im now left with about 30% of the pain I had since a lengthy sport physio treatment plan over 17 courses. I have been able to get back to the gym and press a bit harder. all specialists have now washed their hands of it saying there's no injury to treat so its either phantom pain (feels bloody real) or its my brain still telling the area its hurt, when its actually not.

 

the actual pain feels like intermittent trapped nerve and the specialists all said they think perhaps from C5 neck. I had biracial plexus mri'd recently and all was clear. its tight on breathing deep, like costocondritis and if I lay on my right side it pinches and hurts!

I think im going to have ot just get on with it and live with it and hope overe time it will subside. but thought id fill you in to see your views.

Thanks in advance mate 

 

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Remember that pain occurs so that you DON'T hurt yourself. Thus a clear MRI shows that pain has done its job properly.

The problem is that most therapists' assessment SUCK, and thus can't "find anything".

I need to know more about the exact pain. What you describe sounds more like a shoulder impingement. Then you start talking about nerves.

  • Exactly what movements cause the pain?
  • WHAT sort of pain is it (radiative, lightning, burning, shcoking, aching etc)
  • EXACT location of the pain (draw it on a pic from the web)

It can be brachial plexus but I need more info

(They always come up with some bullshit like "it's all in your head" when they CAN NOT find it! Incompetence is the real cause)

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1 hour ago, Kjetil1234 said:

Remember that pain occurs so that you DON'T hurt yourself. Thus a clear MRI shows that pain has done its job properly.

The problem is that most therapists' assessment SUCK, and thus can't "find anything".

I need to know more about the exact pain. What you describe sounds more like a shoulder impingement. Then you start talking about nerves.

  • Exactly what movements cause the pain?
  • WHAT sort of pain is it (radiative, lightning, burning, shcoking, aching etc)
  • EXACT location of the pain (draw it on a pic from the web)

It can be brachial plexus but I need more info

(They always come up with some bullshit like "it's all in your head" when they CAN NOT find it! Incompetence is the real cause)

Hi yes it did seem like a cop out as they couldn't find the root!!

  • Exactly what movements cause the pain? flys can make it pinch, bent over on a chair and deep breath, if I lay on my right had side in bed (its my right hand side shoulder/neck bu the way that's injured!)
  •  
  • WHAT sort of pain is it (radiative, lightning, burning, shcoking, aching etc) - its a short sharp pain. it used to be a dull ache but ive learned to live with it and I think its subsided into an intermittent flick on and off pain
  •  
  • EXACT location of the pain (draw it on a pic from the web - attached

 

my physio thought it was C5 neck pain and he has done a lot of work on my neck area, needles, massage etc. I have been using stretchy bands at home.

I think a lot is my posture - awful posture. I am trying really hard now to get shoulders back, stand taller and create more space inside me and my nerves!!

pain.jpg

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This is thoracic outlet syndrome.

I'll write more later. No wonder they didn't figure it out, look what "conventional medicine" says about TOS

 

This article is concerned with thoracic outlet compression syndrome (TOCS), one of the most controversial subjects in medicine. It may also be the most underrated, overlooked, misdiagnosed, and probably the most important and difficult to manage peripheral nerve compression in the upper extremity. – Atasoy, 1996

This review was complicated by a lack of generally accepted diagnostic criteria for the diagnosis of TOS. Thoracic outlet syndrome is one of the most controversial diagnoses in clinical medicine. – Povlsen et al., 2014

The diagnosis of neurogenic TOS is more challenging because its symptoms of nerve compression are not unique – Sanders et al., 2008

Conversely, no valid standard diagnostic test is available for disputed neurogenic TOS, resulting in controversies in the frequency of TOS diagnosis – Hooper et al., 2010

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3 hours ago, Kjetil1234 said:

You can try translating my article on this subject with google translate until I'll have time to address it

http://treningogrehab.no/losningen-thoracic-outlet-syndrom-tos/

Thanks i will try and google translate this. 

Id say the pain mainly radiates from the collar bone area if that helps

also, probably the main exercise to bring on the pain (burning type) is BB shrugs which is a shame as i enjoyed them

it will hurt if i pull shoulders back into perfect posture. Its like a short sharp stabbing pain. 

The level of pain when it comes on is the same as when it first occured nearly 3yrs ago

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1: stop slouching with your shoulders. It will depress the clavicle onto the brahcial plexus and irritate it.

2: train the scalenes on the side of symptoms. It'll hurt at first (it should, if not I may be wrong on the diagnosis and your info is not adequate). Let me know how it goes after you've done the exercise for some days. Also need a posture pic to eval scapular position

 

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21 minutes ago, Kjetil1234 said:

1: stop slouching with your shoulders. It will depress the clavicle onto the brahcial plexus and irritate it.

2: train the scalenes on the side of symptoms. It'll hurt at first (it should, if not I may be wrong on the diagnosis and your info is not adequate). Let me know how it goes after you've done the exercise for some days. Also need a posture pic to eval scapular position

 

Ok thanks mate. What pic do u need side on, or the back?

i will try these exercises. Its really annoying now

had brachial plexus mri'd recently and was fine. Also had xray for extra rib up high but its not there

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30 minutes ago, Kjetil1234 said:

1: stop slouching with your shoulders. It will depress the clavicle onto the brahcial plexus and irritate it.

2: train the scalenes on the side of symptoms. It'll hurt at first (it should, if not I may be wrong on the diagnosis and your info is not adequate). Let me know how it goes after you've done the exercise for some days. Also need a posture pic to eval scapular position

 

Also do i need to do both exercises on your video? 

Is that just laying on my left (good side) on floor and sore shoulder in air?

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8 minutes ago, Kjetil1234 said:

Both anterior and middle scalene, yes - the brachial plexus pass between them, and when they're weak, they often irritate it.

Back and (both) sides

Yes, symptomatic side up

Thanks. So if this is this TOS is it easily treatable? Will it require surgery? 

As i say ive been xrayed and mri scan all over and showed no injuries. Also had nerve test done which was clear

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2 hours ago, Baggy said:

Ok thanks mate. What pic do u need side on, or the back?

i will try these exercises. Its really annoying now

had brachial plexus mri'd recently and was fine. Also had xray for extra rib up high but its not there

Ok i just done those. Absolutely killed !! More hurtful when doing the 2nd one at 60 degrees. Felt like my neck and shoulder were all pulling like mad

is that a good or bad sign? Do i still carry on a few times a day? Im not sure what this means

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Perfect that's a great sign. It means there's a 99.9% chance that my diagnosis is correct, AND that it stems from weakness of the scalenes.

Train it CAREFULLY once a day. Don't exaggerate, you'll get a lot worse. To exercise it without causing major pain, it needs to be done with baby steps in the beginning. ONE set, moderate intensity - repeat the day after, if pain is not worse, which in case you'll have to wait 1-2 days more.

There's no official cure for TOS; not even a official way to diagnose. So you're in big luck to be talking with me ;-)

I had a woman come into my clinic with so severe TOS that she couldn't sleep. Had it for three years. Pain was 90% gone in two weeks. So YES, it's treatable. Obviously I can fix things faster in clinic than I can online, but you should get better very fast once the muscles respond properly to training.

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4 hours ago, Kjetil1234 said:

Perfect that's a great sign. It means there's a 99.9% chance that my diagnosis is correct, AND that it stems from weakness of the scalenes.

Train it CAREFULLY once a day. Don't exaggerate, you'll get a lot worse. To exercise it without causing major pain, it needs to be done with baby steps in the beginning. ONE set, moderate intensity - repeat the day after, if pain is not worse, which in case you'll have to wait 1-2 days more.

There's no official cure for TOS; not even a official way to diagnose. So you're in big luck to be talking with me ;-)

I had a woman come into my clinic with so severe TOS that she couldn't sleep. Had it for three years. Pain was 90% gone in two weeks. So YES, it's treatable. Obviously I can fix things faster in clinic than I can online, but you should get better very fast once the muscles respond properly to training.

Thank you. I really appreciate it

so will this neck exercise literally make it better on its own? Or is there a lot more rehab work needed? Would this explain why it burns to do shrugs?

every now and then i think its getting much better then i have a crap day like today where i cant even pull shoulders back into correct posture without lots of pain. I certainly cant ever sleep on the bad side for 3 years now

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If the main compression spot is in the scalenes (which it seems), yes. Strengthen them and they'll stop suffocating the brachial plexus.

If there are several compression spots, it depends whether these are of importance or not. Probably not, as your symptoms are in the TOS area.

Most common causes of tos are:

  • Weak scalenes (by far) which is a result of poor posture and/or lack of proper cervical rotation in gait
  • Depressed clavicle (slouching, lowered shoulders)
  • Compression of radial nerve within the triangular interval (weakness of teres minor, major, and/or long head tricep)
  • Compressed musculocutaneous nerve within the coracobrachialis muscle
  • Median nerve compression beneath the (weak) pronator teres muscle
  • Radial nerve compression beneath the supinator muscle

AND of course, neck herniations, but you've already checked that.

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1 hour ago, Kjetil1234 said:

If the main compression spot is in the scalenes (which it seems), yes. Strengthen them and they'll stop suffocating the brachial plexus.

If there are several compression spots, it depends whether these are of importance or not. Probably not, as your symptoms are in the TOS area.

Most common causes of tos are:

  • Weak scalenes (by far) which is a result of poor posture and/or lack of proper cervical rotation in gait
  • Depressed clavicle (slouching, lowered shoulders)
  • Compression of radial nerve within the triangular interval (weakness of teres minor, major, and/or long head tricep)
  • Compressed musculocutaneous nerve within the coracobrachialis muscle
  • Median nerve compression beneath the (weak) pronator teres muscle
  • Radial nerve compression beneath the supinator muscle

AND of course, neck herniations, but you've already checked that.

Ok thanks. So for now do your exercise once a day and that should help? Is there a next step?

i am also trying to help if by standing tall, tilting neck sideways to my shoulder and holding the stretch - applying small pressure with my arm to get full stretch

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35 minutes ago, Kjetil1234 said:

Stretch? I haven't told you to stretch anything?

Stretching weak muscles make them WORSE

Ah ok my bad i thought that was helpful. 

Will just stick to the one u sent me in video. 

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56 minutes ago, Kjetil1234 said:

Because yawning raises the ribs. And guess which muscles also raise the upper ribs? You guessed it; the scalenes

Ok mate thank you. Can i ask ... how do u specialise in this sector that is so shocking badly known about by apparently 'the best' specialists in the uk?

im going to stick to your exercise once a day and send u pics of side and back

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21 minutes ago, Kjetil1234 said:

Well my background is electro-mechanical engineering. Probably that have helped me more than all the anatomical courses I've taken to be honest. There are good guys out there though, like Dr. Evan Osar who is a real champ

Thanks mate

So if my scapula is too low as you suggested is there a way I can sort that out as well as doing your scalene exercise mate? are my shoulders meant to be higher up in the corners as you look at them from the front/back rather than sloping down do you mean

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