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Explanation and List of Sorehand Topics
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Topics of the day: Date: Fri, 24 Nov 2000 15:18:17 EST Subject: Stellate ganglion nerves & TOS Hi all- Sometimes I know I am one of the luckiest gals in the world. I saw my PT today and he said yesterday he read a new article on TOS and all the lovely things that go with it. He eagerly waiting for me to come in today because he learned a new technique for TOS. He also informed me that what we thought was vascular TOS is really probably neurogentic TOS. He said I am getting the sweaty, cold, speckly hands because of a sympathetic nerve that comes out of T4 and T5 (vertebrae). He had me lie on my tummy on the table. He did some funky trigger point things very close to the ganglion nerve roots at T4 & T5. I havent had *any* pain there at all. When he hit the trigger points I had some INCREDIBLE pain. Horrible, but kinda good at the same time. I cant believe the relief I now have. Sure my hands are cold, but it is much less frequent now and not nearly as cold. I was amazed at how much those little areas next to my spine could hurt when touched but dont hurt when there is no pressure applied. Bizarre. I was wondering if anyone knows more about this kind of thing. The PT did give me "the talk" about surgery. He said he spends a lot of time trying to get people back to functioning because the rib resection surgery doesnt work. He also (his words not mine) said that the scalenectomy is really BAD. He said that the head and neck rely on the scalenes and to have them removed is nonsense. (I kinda agree). He said that surgery is only effective when there is some genetic abnormality or when the scalenes are so shortened and stiff that they cannot be used properly again. Uggh. I am still going to the Surgeon just to rule out any surgery for the Ins Co. I am trying to close some doors and get my options narrowed down. So, any info on ganglion nerves and/or sympathetic nerves is appreciated. Hope everyone is enjoying the long weekend. Take care of those arms. a ------------------------------ ------------------------------ Date: Fri, 24 Nov 2000 21:50:08 -0700 Subject: stellate ganglion nerve FWIW, my understanding is that a stellate ganglion nerve block is sometimes used to block pain so that RSD patients can bear to take part in PT. An anesthetist once explained to me at length that the damaged nerve does regenerate -- verrry slowly -- 1/4 inch a month if I remember right -- but the hazard meanwhile is that muscles atrophy from disuse. Hope this helps. Happy long weekend. cheers, Penney Anne wrote: So, any info on ganglion nerves and/or sympathetic nerves is appreciated. definitions from The On-line Medical Dictionary http://64.4.8.250/cgi-bin/linkrd?_lang=EN&lah=f9b4fe4d50ca1f76f15c0993ffdad6b7&lat=975208156&hm___action=http%3a%2f%2fwww%2egraylab%2eac%2euk%2fomd%2f http://64.4.8.250/cgi-bin/linkrd?_lang=EN&lah=9b973e81becd648582d23249db22fe74&lat=975208156&hm___action=http%3a%2f%2fwww%2egraylab%2eac%2euk%2fcgi%2dbin%2fomd%3fstellate%2bganglion stellate ganglion A paravertebral sympathetic ganglion formed by the fusion of the inferior cervical and first thoracic ganglia. sympathetic nervous system <anatomy, physiology> One of the two divisions of the vertebrate autonomic nervous system (the other being the parasympathetic nervous system). The sympathetic preganglionic neurons have their cell bodies in the thoracic and lumbar regions of the spinal cord and connect to the paravertebral chain of sympathetic ganglia. Innervate heart and blood vessels, sweat glands, viscera and the adrenal medulla. Most sympathetic neurons, but not all, use noradrenaline as a post ganglionic neurotransmitter. autonomic nervous system <anatomy> Neurons that are not under conscious control, comprising two antagonistic components, the sympathetic and parasympathetic nervous systems. The autonomic nervous system regulates key functions including the activity of the cardiac (heart) muscle, smooth muscles (e.g., of the gut), and glands. The autonomic nervous system has two divisions: 1. The sympathetic nervous system that accelerates the heart rate, constricts blood vessels, and raises blood pressure. 2. The parasympathetic nervous system slows the heart rate, increases intestinal and gland activity, and relaxes sphincter muscles. parasympathetic nervous system <anatomy, neurology> One of the two divisions of the vertebrate autonomic nervous sytem. Parasympathetic nerves emerge cranially as pre ganglionic fibres from oculomotor, facial, glossopharyngeal and vagus and from the sacral region of the spinal cord. Most neurons are cholinergic and responses are mediated by muscarinic receptors. The parasympathetic system innervates, for example: salivary glands, thoracic and abdominal viscera, bladder and genitalia. Compare:. Sympathetic nervous system. Penney Kome, author & journalist. Columnist: Editor, Women'space ~~@~~@~~@~~@~~@~~@~~@~~@~~@~~@~~@~~@~~@~~@~~@~~@ ------------------------------ ------------------------------ Date: Sun, 3 Dec 2000 19:44:16 -0400 Subject: Re: Next Sugery!! Hi A I agree totally with you here .. this was basically my story too ... right hand , the dominant and *mouse* (grr) hand was gone cold and dead. I had fought with this since 92 ... GP said no more cortosone shots in the wrist ... Neorosurgeon said do CTS Release to right hand first then left, (left was not as bad mind you) .. right healed up after open CT release ... still upper arm/shoulder problems ... was TOS of course... I did the better nutrition thing .. more water ... yoga myofascial release therapy had trigger points in every single muscle... stretching ... swimming .. whirlpool bath installed ... skating .. off to the gym for more cardio and develop some muscle tone ... I was up to comfortably doing shrugs with 45 lb dumbells and 90 min workout three times a week. I was feeling great and more fit at 40 then ever!!! Summer came and no time for the gym .. was feeling great anyway right ... muscle tone decreased ... shoulder muscles no longer holding everything up and in it's proper place ... fall arrives and guess who is having trouble again ... circulation down .. inflamation ... pain .. tingling in fingers and both hands ... things were looking grim!!:< However, (pregnant pause .. drum roll ...) the gym had shown me the secret!!! PT, my MD, and vascular specialist agree ... decrease in muscle tone and general fitness level means decrease in circulation for me. My PT tells me my shoulder is supposed to float above the ribs on muscles ... deflate those muscles and we have a problem! No more forgetting about the gym ... it's either stay fit or stay in pain! Recovering muscle tone now .. next try to build some endurance into those muscles. So I have a home gym setup now, new treadmill machine, blood circulating through my arm again ... less right hand finger tingling everyday ... try to stay clear of the computer and especially the *mouse* (that still hurts) ... and am fast on the road to recovery and a better lifestyle ... even if it was not by choice! My arm is informing me I am done typing now! h. ------------------------------ Date: Sun, 3 Dec 2000 23:58:12 EST Subject: Re: State of Confusion << What exactly do they need to do to diagnose TOS and would that be the neurologist or orthoped? >> L- Ask your Dr to do what I think is called the Adson's test. (Sorehanders correct me if I am wrong). This is where he will raise and lower your arms and take your pulse. If you have TOS, your pulse will slow or disappear in certain positions. This test is only hands-on and can be done in, oh, 5 minutes. A GP can diagnose this. It is not some highly skilled test. It's merely a range of motion type test. Being a union steward, it angers me that the Union didnt do more to help you. Have you filed a grievance, even for forms sake? May be worth a shot. Not much could come of it, but it may prevent this from happening to anyone else. TOS and Myofascial Pain Syndrome (MPS) can go hand in hand. Some say the MPS can cause TOS. You may benefit from Myofascial Trigger Point Therapy with a PT. This may also be something you talk to the Dr about. Sorry to hear you are in such pain. Try to do something nice for yourself. A. --------------------------- Date: Sun, 3 Dec 2000 22:52:48 -0700 Subject: Re: State of Confusion Hi Linda; Ouch! Sorry to hear about your incident. You asked why you are presenting symptoms of more than one condition. With strain injuries, it's not unusual for a person to have more than one condition -- six or seven, in fact, according to the P/Q book. If you printed out the website about TOS, you probably know that pressure on the brachial plexus, or in the scalenes, or one or two other spots high in the body, can compress more than one nerve, and affect blood vessels too. So the sensations in your fingers may indicate that the position of your upper body affects one or another of these structures. This website has pictures that show certain maneuvers that the doctor can use to diagnose TOS. http://www.nismat.org/ptcor/thoracic_outlet/index.html cheers, Penney ------------------------------ Date: Sat, 13 Jan 2001 06:33:42 EST From: Anne Subject: Re: help (TOS) T- I am so glad you found us, but I am sad you have TOS symptoms. Many times, TOS can be exacerbated by Myofascial Pain Syndrome (MPS). Since you were at the 'puter for hours on end, I will assume the TOS was started due to many things, but mainly bad posture. (Read: gargoyle posture, head pushed forward, rounded shoulders, etc.) I would talk to your Dr about Physical Therapy (PT) called Trigger Point Therapy. This will help with the lumps (muscular) in your shoulders and upper back (shoulder blades, armpits, etc). Feel free to email me anytime off list, if you want. I would be more than happy to "talk TOS" and to offer suggestions/ideas/war stories. Where are you located? (state/province)? There is also a TOS-specific message board at: http://neuro-mancer.mgh.harvard.edu Click on the Thoracic outlet link. This is a good resource for questions. Take care, A. ------------------------------ Date: Sun, 4 Feb 2001 14:48:46 -0400 Subject: Neck Problem / TOS / Chiropractic Question Hi All I am still trying to peel back all the damage from my years of poor posture and too much computer (especially the mouse .. grrr) . With myofascial release therapy, calcium magnesium, lots of water, my special apple cider vinegar remedy ( Hi Penny! ) I have cleared all of the *known / detectable* trigger points in my right arm, shoulder, and my back. The open carpal tunnel release ( 2 yrs ago now) on the right hand is working out fine for me. I of course do my stretching daily, drink lots of water, and work out at least twice a week now ... nothing like 10-15 mins (heart rate usually at 130-140) on the treadmill at 4mph to get the blood circulating! I am still having circulatory issues with my right arm and it is agreed now that it is TOS caused by scalene muscles too tight (anterior and posterior) and apparently from my xray and exam by the chiropractor there is not proper alignment / clearance in my C3 to C7. Of course the nerve roots involved are the areas giving me all my trouble .. from my rhomboids and teres major down my arm and to the top two fingers in my right hand (this being the median nerve I am expecting to be partially the fault of the scalenes being too tight). My chiroprator seems quite up on TOS and says it was his thesis or whatever it is called in Chiropractic school, he had to do a study on a person with trauma induced TOS (a skiing accident I think he said) ... any way he has started adjustments in mid back (T4 & T5) ... he felt an adjustment on T4 .. T5 I heard the little "click" and this week will attempt the C3 to C7 area I believe. He has done the quick little turns on my neck and it goes with no problem. This week I also tried some muscle relaxants to see what they might do for me ... symptoms almost totally went away!!! This is making me look very closely at the impact those scalene muscles are having on my circulation. My question is .. am I pursuing the right tack with the chiropractor .. any other advice??? ---------------------------------------------------------------------- Date: Thu, 8 Feb 2001 01:39:18 -0800 Subject: Re: tos questions L- The actual word is crush, double crush. The idea is that there are two areas of neural and vascular compression. The Pt was talking about where the brachial plexus(read nerve trunk for the arm and hand) and the brachial artery(blood supply for same )go between the clavicle and the first rib. If there is a structural dysfunction, the two bones can get to pinching there as well as possibly in the carpal tunnel. I am skeptical of blaming ribs,because did they suddenly grow or did the clavicle get thicker? No the support and movement structure got out of balance and by contraction, drew the two together. In the case of the area I'm talking about is the scalene muscles that assist in respiration(lifting the rib at the end of an inhale, then hopefully letting it drop back down).The clavicle or upper thoracics can be involved but tht's where I'd look and try to release first. Whether it is Movement oriented, like Feldenkrais or Hannah Somatics, manual oriented like Trigger point therapy myofascial release, osteo or what I do, Bowen. The point is to get the area to let up on contraction. You can check for yourself if the area is problematic. The scaleni ar the little muscle tht feel like they runn fromthe inner border of your clavicle partway up the side of your neck. If they are very tender and taut when you run your fingers over them they need work. It is the same in shoulder impingement, the bones of the arm and shoulder didn't grow together, they were brought closer by the soft tissue, but the response is to try in either case to wrench them apart with therapy and exercise and failing that, cutting off part of something bony. Sort of "if thine eye offends thee, pluck it out". I see a lot of impingement and carpal tunnel along with somr TOS in my private practice as well as a lot more when I worked at a busy sports and ortho clinic. The soft tissue doesn't roll over and play dead frommodalities and exercise, the mainstay fo PT. The accomodating force that brought the area into contraction has to be addressed or the area returns to contraction after the session. I am not trying to criticise your therapist, but usually they don'tt have the time to spend doing a lot of hands-on therapy on one patient. Sometimes they haven't found a manual therapy form that works for them. I suggest asking about adding soft tissue therapies ! either through your M.D./P.T.or on your own dime. It can't hurt and that rib reduction doesn't have great resultsas far as I've seen, especially since there isn't any way to undo it. Hope that was helpful,FWIW K. -----Original Message----- From: L- Sent: Wed, 7 Feb 2001 23:17:54 -0800 Subject: tos questions Hi All, Well I was back at the DR. on Tuesday. She agrees that what is going on is DOUBLE CRUNCH? (Carpel tunnel and TOS) She said that if PT doesn't help then what they normally do is remove the first rib to relieve the nerve? I hope that I heard her right. I was in another world when I was there that day. I haven't been sleeping much at night. (AGAIN) Is there anyone out there who has had this procedure done? I go for more EMG's in 3 weeks. She also prescribed a medicine called Neurontin. I started taking it this morning. Has anyone taken this? Thanks, L. ------------------------------ Date: Wed, 7 Feb 2001 08:13:44 -0800 Subject: Re: tried it all D- Your story sounds similar to mine. When I wasn't able to get near a computer without reactivation of symptoms, I persevered by taking Bates Lessons for improved eyesight. As soon as I was able to identify how I was holding myself at the computer (started by "staring"), I was able to adjust my eyes and gaze. Since then, I have been working at the computer. Also, as a Feldenkrais teacher, I would look further down and notice how you use your pelvis while sitting at the keyboard. A pattern of flexion in the back and extension in the chest is common with people with neck and arm problems. Also, as a person who's been there with TOS, I can tell you that it takes a long time for soft tissue injuries to heal, especially tendons. In my opinion, this is because at the root of the injury is the conditioned patterns of holding the body stiff when doing something that caused pain in the past. Kind of like Pavlov's dog salivating at the sound of a bell in anticipation of being fed. A good book that showed me the power of my thinking, "Frogs into Princes" by Richard Bandler and John Grinder, as well as "Change Your Brain" by the same authors was helpful. These researchers are the creators of NLP, neurolinguistic programming. Good luck, E. ------------------------------ Date: Sun, 11 Feb 2001 22:29:00 EST Subject: Re: TOS? Neurogenic TOS can also present the same symptoms you are describing. I am not a Dr, but I would bet that your TOS is neurogenic and not vascular, but you never know. Vascular TOS will have swelling, most often. A. -------------------------- Date: Wed, 4 Apr 2001 17:20:10 -0000 From: C. Subject: TOS With TOS raising your arms straight up above your head should produce some symptoms. For me it is the opposite, when i raise my arms straight up I get circulation back into my hands, and when they are down at my side the circulation is terrible. Sound familiar to anyone? --------------------------
K-
I can hear from the silence that all the other Sorehanders are waiting for me
to make my Thoracic Outlet speech. Consider this an addition to Readsorehand's
advice about myotherapy, and body movement, with which I agree.
I have had many of the symptoms you've had (and am a graphics intensive sorta
guy), and still have a propensity for some. The wrist injury adds significant
complexity---that I couldn't even begin to speculate on---such that only a licensed
healthcare professional should be entrusted with your health, and not at a distance.
I've simplified the letter you wrote, below, and will address a mythical person
about whom we know only those 13 points. Only you and more investigation can
prove if it's applicable, or how much:
The situation is remarkable for the suddenness (2 weeks) with which computer
graphics work brought on symptoms that a career of painting did not. But it
is likely not to be a coincidence. I speculate that a career at the easel strengthens
the muscles holding up the arms. But painting, as you state, is hardly a static
activity. Modern computer pointing devices, are by technological design quite
the opposite; the mantra of industrialization is economy of motion. This "efficient"
design in which one hardly moves the electronic "brush" at all, combined with
muscle tone already in the chest/armpit has overwhelmed the design of the human
body. The design concerns a passage in the chest called the thoracic outlet,
and/or the spot where the blood vessels and nerves (neurovascular bundle) pass
through the armpit (axilla?). These spots are brilliantly designed for a lifetime
of use and even abuse. But they are unlikely to be designed for 8 hours-a-day
in one position, or they can pinch things off. It would be reasonable to expect
that the blood vessels get kinked like a garden hose, and are forever(?) less
perfect. (Sorehanders: are there any cadaver findings to this effect?)
To this dangerous mix, one might have such an intensive work style... and be
at such a point in the aging process... that even scraping a palette could bring
on tendinitis. Elise's poignant comment yesterday about "conditioned patterns
of holding the body stiff," (link below) cuts to the heart of this issue and
may be a part of your puzzle.
The chilly room is merely a circumstance that makes the symptoms more noticable.
The perplexing array of sensations other than pure pain are what I understand
to be hallmarks of (blood flow related?) TOS, though some TOS sufferers are
apparently in quite significant pain as well.
The doctor who doesn't know, the ibuprofen and splints, were surely added to
the story for the bemusement of long-time sorehanders (sorry, if we don't laugh
about this stuff, we'd cry).
The reaction to stretches suggest that you're simply not ready for stretching
yet, no matter how important they might be later. The overall circumstances
suggest that addressing TOS or armpit compression alone is not going to solve
your situation. The whole upper extremity and workstyle must be addressed.
I've gone to such lengths to state this case because---though I don't think
of myself as an alarmist---I predict that graphic
artists, combined with the Web phenomenon, are going to be the next wave
of serious RSI sufferers. There seems to be a several-year incubation time for
chronic RSI, and graphic artists only got prolific on the web 2 years ago. I'd
love to be wrong.
After you heal, learn to work
in motion. Fidget.
Good luck, Jack
Resources:
A post just yesterday was excellent on TOS (and Elise's comments). Read it and
my entire collection of TOS posts at:
http://www.rsiprogram.com/sorehand/thoracicoutlet.htm
Diagnostic Tests (Print them out and find someone who can administer them?:
http://www.nismat.org/ptcor/thoracic_outlet/index.html
My collection of TOS stuff:
www.RSIProgram.com then click on the book "RSI Details."
-----Original Message-----
Sent: Wed, 7 Feb 2001 11:08:46 -0600
To: SOREHAND@ITSSRV1.UCSF.EDU
Subject: weird wrist
1) My doctor is of no help
2) I'm at my wits end and don't know where to turn next.
3) I'm an artist, a painter. I paint standing up...moving around a fair bit.
4) Two very mild cases of tendinitis after scraping my palette too vigorously
and doing a lot of gardening at the same time.
5) I spent a couple of weeks learning a graphics program on the
computer, using a graphics tablet and stylus. This involved a lot of
holding the stylus and wrist bending.
6) The room is chilly and I often ended up with a very cold hand after several
hours of working.
7) After a couple of weeks of working on this including some mousing my wrist/thumb/back
of the hand was stiff and very "zingy" and heavy feeling.
8) stopped it entirely for 10 days ...hasn't ever felt normal since then...
feels heavy, hot, tight and zingy again, or feels wet when it's not.
9) 5 years ago I broke that wrist... instead of a cast metal pins... doctor
(orthopedic/sports medicine hand specialist) says the scar tissue is irritating
the nerve.
10) [Dr.'s] recommendation was ibuprofen, maybe splints. I have taken up to
600 mgs. of ibuprofen with no effect at all, and that I've been wearing a splint
at night.
11) Not really in much pain, and what pain there is, is dull and not constant.
It's more of a tightness and tingling/burning sensation.
12) The only things that have offered any relief are: cold water (short-term
relief) or really immobilizing it (leaving it motionless on a cushion or hanging
at my side, not even using it to brush my teeth)
13) Stretches activate symptoms when I do them.
Thanks for your patience.
K.
Explanation and List of Sorehand Topics
Copyright for all materials belongs to the original authors. Do not repost or reprint without permission from the author. Search for the author by joining Sorehand and posting a message or searching for their name.