Thoracic Impingement (Outlet) Syndrome?

[endurancell]

I have been dealing with severe shoulder issues in my right shoulder and even down the whole right arm and right trapezius/right side of neck for quite some time. I have had a very uncomfortable tightness and discomfort coming from what I thought was the right shoulder that effects most of my right upper body. Sorta like a strain that never goes away, localized in what feels like the brachial plexus and resonates out and down the arm. I am/was unable to work out and even get a pump in my right arm and chest/lat from this for 2 years and my right arm has atrophied to an 1.5 inches smaller than the left.

2 years ago I had an MRI of the neck that showed mild cervical stenosis, I assumed this had something to do with it because an MRI of the R brachial plexus came back fine and the right shoulder showed only mild bursitis and tenonditis.

My new MRI of the R shoulder showed "prominent potentially dilated vessels" then the radiologist went on to write "If a specific etiology for symptoms remains questionable, a thoracic impingement syndrome might be considered." Now I researched thoracic impingement syndrome (or thoracic outlet syndom, TOC) and I think i kinda fit the description but not completely. Also, if this is the case, and the radiologist cant even tell by the MRI, how can this be diagnosed? Has anyone here ever suffered from this or had experience or heard of it? I have a follow up with the doc that ordered the scan next week and I still have to get a new MRI of the neck.

[TmdRockz]

do u feel tingling near scapula ?

[endurancell]

do u feel tingling near scapula ?

Occasionally there is a slight tingling that seems to be emanating from the neck into the traps and around the scapula

[riseboi]

A physical or physical therapist well versed in the evaluation and provocative tests for neural tension/compression will be able to help rule in/out TOS.

[kyoun1e]

I've overcome TOS on both my right and left side. Both times I experienced extreme pain in the scapular region and lost about 2/3 of my strength in my tricep.

TOS is usually diagnosed by exclusion since it's so difficult to pin down. That said, I would find a specialist in TOS to diagnose. These surgeons are usually vascular surgeons since they deal with impingement of veins and arteries.

I originally had my diagnosis confirmed via an MRA (not an MRI) of the chest. This provides imagery of the blood vessels and the degree to which they are impinged or not. There are also other exams you can have. I had a CT Scan of my neck that showed I have an "extra cervical rib" that makes me more predisposed to this kind of compression. Also, there are blood circulation tests that can be done.

At any rate, unless you have something unique going on in your anatomy (i.e. extra rib) or have suffered some kind of traumatic accident (i.e. car crash) that changes your anatomy fundamentally, I think you can work this out. I did.

If you're like most, you've probably spent quite a bit of time working out your chest and shoulders. If you haven't been vigilant with stretching and have also failed to balance this work with posterior training (i.e. romboids, mid to low traps) you could have a forward shoulder. In this case, the weakness of the back muscles and the tightness of pec minor pulls your shoulders forward. This creates less space for your nerves to flow from the neck, under the collarbone, and down your arm. Result: Nerve compression, odd sensations, and if it goes too far, muscle atrophy.

How you fix it:

* STOP doing chest and shoulder work.
* Intense tissue work on pec minor and subclavious muscles. Get a raquetball and beat the hell out of these muscles. You have to loosen.
* Once you're loose, you need to encourage the humeral head to move back even more. Strengthen the back muscles via one arm rows and any movement that improves low to mid traps. This will help pull the shoulder and scapula back and down.
* Posture: This is critical as well. Forward shoulder roll and head forward lean usually go together. The more you do this the more you encourage tight anterior muscles. Chin tucks are one good exercise to help here. To be honest, I've had a great experience with FoundationTraining.com. It strengthens all of the posterior or "core" muscles up and down the spine and makes it easier for you to stand up straight and strong.

Anyways, I've been down this road. PM me if you have any questions.

KY