[patrice]

#11978

Thank you again, Dr. Corenman.

The surgical options for TOS are unsettling. Some vascular surgeons do just a scalenectomy and others opt for rib resection, so I have found. The outcomes are very variable. Tough spot to be in…..So disabling yet no clear solutions. Trying to become as educated as possible.

[Donald Corenman, MD, DC]

#11979

My understanding is that first rib resection is essential for full decompression of the brachial plexus. There are three areas that can compress the plexus. The scaleni muscles are only one of the three. The most common area is between the clavicle and first rib. You are correct that this surgery takes some time to recover. Just make sure that you select a meticulous surgeon who has great experience.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[patrice]

#11988

You have been so helpful, Dr. Corenman, and I am extremely grateful for that. The main surgeon in Seattle, who is the TOS expert, does only the scalenectomy and I have just not felt comfortable with the results that I have been hearing. There is a surgeon in Denver that has been highly recommended and also one in Los Angeles. I am willing to travel to know my options.

Thank you!!!

[Donald Corenman, MD, DC]

#11992

The Denver surgeon I have heard might be good. He took over for Saunders who I understood retired. Do some research. Call the surgeon’s office and see if you can talk to three consecutive patients who have undergone the surgery.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[patrice]

#11994

Great advice!
I believe that Dr. Saunders is still diagnosing and Dr. Annest is doing the surgery. He is in his 80’s and may have just retired though. I was considering going to Dr. Hugh Gelabert at UCLA Medical Center. He seems so well liked and they are doing some interesting imaging for TOS there. I understand that there is a doctor at Stanford who is knowledgable as well. If you have any feedback, I am all ears but I am not trying to put you in an awkward position. You have been amazing with helping me! I am taking all of your words to heart. No pressures.

When the PT told me that I had C1 C2 instability as well, I became concerned about creating further cervical instability with surgery and also questioned what was coming from that issue and what from the TOS. It has been a wild ride.

[pete1220]

#11996

Dr Corenman, I would like to get you’re opinion one my situation as I’ve been dealing with a number of symptoms since my accident with no diagnosis. I will try to sum up my situation as shortly as possible. Last June I had an accident where I fell off an ATV and hit hard ground face first, I did not have time to put my hands out to brace the fall. I had a helmet on which protected my head but actually added leverage to my neck. My neck whipped backwards and I heard a pretty sizable crunch in my neck during the fall. immediately after the fall I stood up and was very dazed I had a very bloody nose. Due to an unrelated hospital visit 6 weeks prior I stupidly chose to not go to the hospital and get checked out. The days following the fall I had a moderate stiff sore neck but not many other symptoms at all, I was pretty much living a normal life. About two weeks after the accident I visited a friend out of state and was back riding my ATV. While I was riding my ATV that day I went over a bump and my head swang forward to my chest as if I had no muscle control to keep it up. It was a very alarming feeling but I did not think much of it. Well, about half hour after that happened I started getting extremely light headed dizzy and my heart was racing out of my chest and I went to the hospital. At that point I did not think my symptoms were related to the accident I had weeks prior and the hospital chaulked it up to anxiety and sent me on my way, even though I told them I had no prior history of anxiety. Well, immediately following that day is when all hell broke loose, I woke up the next morning with the most horrible symptoms that persisted for close to 3 months! I went from a perfectly healthy 38 year old man to nearly crippled with symptoms. I can best describe my symptoms as I basically felt like my body was shutting down, my arms and hands and chest were numb,I became extremely weak and lethargic, I lost close to 20 pounds of muscle mass in under six weeks even though I was keeping my eating habits up and still trying to exercise and remain physical through everything. my head began to feel extremely heavy an unsupported, My face became numb, I developed an extremely odd in tolerance to vibration and movement like driving in a car, and developed loud tinnitus in both my ears. I was light headed and dizzy and nauseous. I developed jaw tension and pain, and pressure and popping in my ears.
And during all this is where I began my major diagnostic nightmare, going from doctor to doctor test after test with no clear answers. The main problem was in the beginning couple months through all the doctors visits I was mainly focusing on the hospital visit I had 6 weeks prior to my accident that I mentioned which was due to me inhaling what was thought to be mold while cleaning a basement which gave me symptoms of tight chest and racing heart. So basically I would go to all these doctors and say I inhaled mold that believe is still attacking my system and oh by the way I had an accident where I fell on my head and neck as well.
I won’t go into every single test and doctor I’ve seen but needless to say I have covered every base that I can twice over. 4 neuros, 2 cardios, 2 ents, 2 endocrinologist, 2 rheumatologist, 3 neurosurgeon and orthopedic surgeons, 1 neurontologist, 2 psychiatrist, and I’m sure I’m forgetting a few.
I have had 3 cervical MRI’s, 2 brain MRIs(with circle of Willis), 1 MRI of the TMJ joint and inner cochlear area. Literally about 60 different Static X ray views of my neck. 2 twenty four hour Holter moniter tests. Artery sonograms, and a plethora of blood work ups. And the list goes on and on with testing.
My first cervical MRI was about 7 weeks after the fall, which showed c4 c5 and c5 c6 herniations and bulges in every other cervical disc, as well as herniations at t3 t4. Due to the size an locations of the herniation and Bulges the doctor was not alarmed and even recommended I start seeing a chiropractor. Chiropractic visits started and ended rather quickly as I was feeling they were only exacerbating my situation, and all the doctors said it was in my head.
Fast forward four months after the accident(October) my relentless symptoms and obsessive googling lead me to the thought of cervical instability and cranio cervical instability. I began presenting to doctors with this thought, and I can’t begin to tell you how many times I was dismissed or the doctors saw some instability in my neck with my X rays but said it was not severe enough to justify the symptoms.
Having to take things into my own hands, paying for treatments and tests that were not covered through my insurance and seeing certain doctors that we’re also out of network I continued looking fot a reason for my symptoms.
I saw 2 separate upper cervical specific chiropractors in Manhattan, nucca and atlas orthogonal. Both of which state i have a moderate to severe subluxation of c1-c2. I received an adjustment from each with no change in symptoms except for a stiffer neck.
About 3 weeks ago I traveled out of state to have a digital motion X ray done, as I could not find anyone in the area that did the test. The findings of the tests are as follows: straightening of the cervical lordosis, anterolisthesis and retrolisthesis c2 through c6, facet gapping c4 through c7,oblique extension is restricted, atlas lateral shift left 3.96mm and right 3.10, motion integrity translation C2- 3.43mm , C3- 4.58mm, C4-3.98mm, C5- 4.86mm,
Motion integrity angular(angle/difference)
C2- 7.77/4.05, C3- 3.72/-0.77, C4- 4.49/0.77, C5- 4.50/0.02
Now based on my findings a lot of these numbers are not a good thing at all, I presented this test findings to two of the top doctors here in New York, a neurosurgeon for LIJ and a spine doctor at New York Presbyterian. Both unrelated doctors we’re not concerned with the findings of the test and said it did not correlate with my symptoms. one of the doctors strongly urged me to get back out there and start having a normal active physical life even though I have told him my intolerance to physical exertion and movement is bad.
I stressed to one of the doctors that I feel I may have craniocervical instability as well as c1-c2 instability playing a major role in my symptoms and he strongly disagreed. He said if the ligaments in that area were damaged they would light up bright as day on the 3T MRI I had 2 months ago with STIR sequence, this study was to pay particular attention to the upper cervical junction and ligaments. The radiology report from this test states upper cervical ligaments are normal. I was again consistent with this doctor stressing that something is majorly wrong and I can feel it, I even brought up the fact that I have not had a cervical CT scan which at this point it would be unnecessary but maybe there was a missed fracture in the beginning. he said if I had a fresher I would have been in terrible pain after the accident, which I wasn’t.
He reluctantly wrote me a prescription for a cervical CT scan and cervical angiogram. I am extremely hesitant to get this test based on all the radiation I’ve been exposed to in the past 7 months..I did not mention earlier that I have also had three CT scans, 2 brain and adrenal gland since the accident. So you could certainly understand my reservation for exposure to more radiation.
So basically Here I am 7 months from the accident and my never ending and relentless symptoms that I live with daily are as follows: strong popping and cracking of both ears, tinitus of the right ear, very strong and frequent heart palpitations which get exacerbated with neck motion, a very odd sensation of my head being loose on my neck and too heavy for my neck to support, a heavy strong heartbeat most of the time that I could actually feel pulsing through my neck, lightheadedness and intermittent nausea, weakness and some tingling in both my hands, a tremendous amount of loss of muscle tone and strength of my shoulders and brachial region. A lot of crunching cracking and popping inside my neck especially at the top of my neck base of my skull. And strong intolerance to much of any vibration and movement even fast walking sometimes which all seems to exacerbate my feelings and symptoms.
At 7 months out now and basically being told by so many doctors that nothing is catastrophicly wrong and to get on with my life I am at my wits end with this. I have a 2 year old son a wife and a mortgage to support and I can barely get out of bed in the morning to go to work yet alone complete my daily tasks at work which by the way are of a physical nature which require me to run machinery and undergo some vibration and odd body positions.
I am strongly considering cervical PRP injections as I have spoken with three doctors throughout the country who stress I would definitely be helped with this procedure. but to be honest with you I am scared and terrified of having needles anywhere near that portion of my neck especially the upper neck which I just don’t understand how they could accurately place the substance where it needs to go without serious risk to the patient.
So here I am, basically lost, confused and a shell of myself with very little direction as to where to go. But regardless the more time progresses my symptoms do not change and sometimes I swear they are getting worse to some degree.
Any advice, opinion or direction you could provide I would more than greatly appreciate it.
Oh and by the way one of the main reasons a lot of these doctors have dismissed upper cervical instability and craniocervical instability is my lack of headaches and neck pain.
Oh and forgot one of my main symptoms. I have an extremely odd sensation as i turn my head left to right “no motion”, its as if the muscles nerves in my face especially around my nose region get iritaded as a turn my head. I also have a sensitive scalp like the nerves going to that region are on overdrive. And lastly, I get an intermittent sensation iritation in the back of my throat often.

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