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FREE BOOK THORACIC OUTLET SYNDROME – Chapter IX – Case Histories

 

You are reading Chapter IX – Case Histories


FREE BOOK

THORACIC OUTLET SYNDROME 

by Dr James Stoxen DC

Chapter IX

 Case Histories 


Table of Contents

Preface
Introduction
The Sonny Burke Story

Chapter I      What is Thoracic Outlet Syndrome? (TOS)
Chapter II     Anatomy 
Chapter III    The TOS Controversy
Chapter IV    History, Cause, and Patient Presentations
Chapter V     Physical Examination Findings
Chapter VI    Diagnostic Tests 
Chapter VII   Standard of Care Approaches – Surgical and Non-Surgical 
Chapter VIII  Frequently Asked Questions 
Chapter IX    Case Histories of Patients 
Chapter X     The Human Spring Approach to Treatment and Prevention


 Chapter IX

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Case History Of Patients With Thoracic Outlet Syndrome

Here are some interesting ways I determined the cause of a patients recurring tos from their habits

1.  The Music Legend – Sonny Burke

I was working for Steely Dan backstage one night when one of the musicians brought his friend to me and asked for my help.

He said he suspected his friend had a serious problem when he couldnt get a grip on or lift the top of the miso soup bowl off. I didn’t know who he was but later found out I was working with a music legend. Sonny Burke played piano for Smokey Robinson for 34 years. As a top studio musician he had over 200 record albums and 1000 musical assignments including the entire ‘Saturday night fever’ album, Jackson 5 ‘Dancin Machine’, and other Grammy award-winning artists.

Yet when I met him that day backstage, Sonny couldn’t play at all….his arms and hands were completely numb and too weak play. He couldn’t even button his shirt, open a door or take the top off the miso soup.

“It had been going on for four years. I couldn’t even make a fist,” he said. “I went to five top doctors. First they told me I had ulnar nerve entrapment. I had surgery for that and it did nothing. Then they diagnosed me with diabetic neuropathy. They said nothing could be done about that. I had to live with it.

I had given up hope for a cure for my numbness and severe weakness after seeing 5 top doctors who operated on me and did every test and treatment they knew including surgery. They finally told me there was nothing that could be done so I had to retire from music.

“When he told me he had diabetic neuropathy I didn’t think I could help him, My only hope was that he was misdiagnosed.

When he told me he watched TV in bed…then I knew it could be TOS,”

He told me that the numbness came on in his left hand 4th and 5th fingers first and in the forearm where your funny bone shocks you.  At first, he said the doctors said he had ulnar nerve entrapment because this is the distribution of the nerve.  So they did an operation to remove the ulnar nerve from the elbow.  That left a 7 inch scar yet still no improvement.  While he was recovering from the surgery he noticed the numbness went into the entire hand on the left and into the entire arm and shoulder next.  After 3 more weeks it progressed rapidly into the right side starting from the same 4th and 5th digit then through the hand and up the arm.

A month later his hands started to swell and they got cold.  That is when he could not make a fist anymore, button his shirt or unlock the door to his house.  Thats when he went to 5 neurologists looking for answers.  Unfortunately, all of them misdiagnosed his condition.

If you know diabetic neuropathy you know it effects circulation and nerves.  So it almost always starts distally in the toes and works its way up the feet and legs.  It doesnt start in the hands first.  If it did it would start in the finger tips (distal to proximal) and work its way up the arm. This numbness started in the bottom of the neck on the left.  As the rib was elevated more and more by scalene muscle tension it encroached on nerves higher into the brachial plexus.

When he was recovering he was now leaning back 10-12 hours a day resting per doctors orders in the bed.  Thats when the TOS took off.  As the tension in the scalenes got more and more intense they lifted the first rib even higher and got more swollen and choked off the blood flow out of the arms at the outlet.  That is when the blood could not escape his arms and his hands got swollen from the back up of blood.

When he started using his laptop in bed and the remote the pec minor spasmed and pulled the shoulder girdle down with the collar bone meeting the elevated 1st ribs and that squeezed the artery blood flow into the arm. That is when the hands got very cold.

After examining him I found out indeed it was TOS. Apparently the doctors did not ask about the leaning back in the bed for 3-5 hours a day or check him thoroughly.

So imagine this… After hes been checked by the top 5 neurologists in the country he is told he has diabetic neuropathy.  He completely retires from playing as one of the top studio musicians int the world and touring with Smokey Robinson, one of the legends in the music industry.  Then this chiropractor he doesnt know does a 7 minute history and a 6 minute examination backstage at a Steely Dan concert and tells him that without a doubt he has been misdiagnosed by every top neurologist he has consulted with previously.

I looked at him and said “I bet you dont believe me.”

He said, “Well… no, not exactly.”

I said, I understand.  “Now do you want me to prove it?”

He said, “Yes, can you?”

I said, “I think I can prove it to you in about 15 minutes. Hows that?”

He said, “What do I have to lose”  Do your worst

So I asked him to lay on his side looking horizontal to the ground and relax. I put a pillow under his head so his neck was straight.  Then I got a towel, folded it in half and put it on his neck.  Then I tool a 4 inch circumference rubber headed clinical strength vibrational massage machine, placed the head of the massager at 5400 RPMs on his scalenes, muscles of his neck and shoulders (floor 1 compression) and then on the pec minor, latissimus dorsi (floor 2 compression) and observed his facial expressions.

I was waiting for his eyes to light up and they did.  Then he starts screaming “My arm is on fire!!!!!”  “I knew he would say that”  Remember the machine is loud so he is screaming over the machine noise into the theater “MY ARM IS ON FIRE”   The first rule of being in an old theatre like the Chicago Theatre is you never scream out that anything is on fire when its not literally on fire.  It could cause a stampede of people running out of the building!!!

Also I could just imagine what production managers, tour managers and other support were thinking as this older man was screaming his arm was on fire while this man had this machine into his neck.

I calmly turned off the vibration machine, looked down at him and said, “Sonny, do you remember as a kid waking up with a numb arm from sleeping on it?

“yes”

“Well do you know why your arm feels like its on fire?”

“No”

“Its because the blood is finally flowing back into the arm after being drained for 5 years.  Now make a fist!” He looked down and squeezed his hand into a fist, amazed.

“Could you do that before you came here tonight?

“no”  

“Did the doctors say diabetic neuropathy would improve drastically in 10-12 minutes of treatment?”

“no, they said it was a permanent condition”  

“Do you still think you have diabetic neuropathy?”

“No” 

So it was 8:00 p.m. when I started and by 8:30 p.m. I stopped and said, “I think you realize that your condition was misdiagnosed.  You have thoracic outlet syndrome. We may be able to reverse this 100% so you can play piano again.  How does that sound?”

“Great!”

“Ok, so here is my card.  Call me on Monday and lets get started on this first thing. I will treat you as a VIP and we will treat it 3-4 hours a day until we have reached maximum medical improvement. Now, lets go upstairs and watch Steely Dan. They are one of my favorites and we have backstage passes so we should be able to get up close”

He said “Watch Steely Dan!?. I can watch Steely Dan anytime I want!  I need you to do more treatment now!”

UGH!  So I obliged and worked on him another 1.5 hours.  There was enough time to hear one song of Steely Dan.   I was approached by the production manager that night who said “not everyone got treated. Can you work more at our hotel?”  So I went to their hotel at 11 p.m. and worked from then all night, through the next morning, the whole next day until 6:00 p.m. till the last person on the tour was treated.  I went home, got a shower and went on a date.  It was our first date so I asked her “So what did you do last night?”   She said, “I got to see Steely Dan! Have you ever seen Steely Dan or know any of their songs?”

I took the next day off.  I think I deserved it after working 33 hours straight.

I worked on Sonny with deep tissue in floor 1, floor 2 compression spasms and in his arms too for about 30 hours to reverse his TOS to maximum medical improvement.  That is what it took and that is what it takes to reverse an engrained TOS complex.  I cant tell you how many doctors have done 10 minutes of electric stimulation, 10 minutes of ultrasound, (both innefective for toe), some stretches of the neck (makes TOS worse) then an adjustment 3 days a week thinking that will reverse a very severe TOS.  My clinical opinion after seeing some of the worse cases is that this is not possible.  That is my opinion and Im entitled to my opinion.

Watch TV in bed, even with a pillow, and those muscles are constantly contracted for hours at a time. It’s similar to holding a ten pound weight at arm’s length. What happens? Your scalenes go into constant spasm.”

When that happens, the scalenes lift their attached first rib. That compresses the nerves and vessels against the overlying collarbone, and causes the symptoms of TOS. Besides weakness, those symptoms can include tingling, neck pain, shoulder problems, and headaches.  The spasms in the forearms and arm muscles came from playing piano for 50 years for 6-8 hours a day without some tune up deep tissue of these muscles.

I have worked many of the top guitar players in the world and I go right to the finger, hand, forearm and arm muscles working the deep tissue. I ask them if they have ever had this done and they all say no.  Shocking!  They love it so do it.

When the shoulder girdle is compressed down it can cause the collar bone to compress the artery, vein and nerves as they pass underneath. If the pectoralis minor is swollen it can compress the artery, vein and nerves as it passes underneath or both.

Sonny was on disability from playing professional piano as a studio musician and touring with Smokey Robinson for five years because of his problem being misdiagnosed. He had access to the best of the best in the world and still was misdiagnosed.

Just because you have a doctor or two tell you , you have carpal tunnel, pinched nerve, tos and need an operation…  If you think you have TOS and think you need a second opinion, get it!

2.  The Day Trader TOS Patient – a patient came to me suffering from TOS for 6 years with symptoms getting progressively worse. He had gone to 7 neurologists, 5 orthopedic surgeons, 9 chiropractors, 12 massage therapists and 5 physical therapists. He had all about given up until he read this article.

He came to me and said that after his treatment he felt better. Then he went home, turned on the TV to watch the stock news, grabbed his coffee and lap top, sat down in the lazy boy chair leaned back with is lap top resting on his lap and watched TV and traded for 3-5 hours.

His head was dangling by his constantly contracting scalenes compressing floor I and his arms were working the computer in an outstretched position contracting the pec minor and lats for hours contracting floor II.

When he promised to never ever do that again we worked 15 hours in 5 days releasing floor one and two. He was happy about his progress but still felt it wasnt right. He was anxious and agitated about it so I asked him to show me his sitting posture he was so proud of. His perpendicular sitting posture was a 15 degree lean backwards that we noted when we took a photo of him sitting. That ended the argument about what was bringing his symptoms back. After he made the final adjustments on what is truely the perpendicular posture for sitting his TOS corrected with 10 more hours of deep tissue and adjustments. He is working out 3 days a week now after realizing that even though he was thin and looked fit his neck muscles could not move 5 pounds in forward neck bending, side bending right and left and back bending. How can your muscles support a 9 pound head when they cannot resist 5 pounds on the neck machine. Also even though you can do the neck machine for 10 pounds not even Ed Coan (22 inch neck) can hold a 9 pound weight for more than a few minutes in a sustained contraction without causing a compressive force spasm on the spring

3. The 19-Year Old Lacrosse Player – A man contacted me after reading this article. He said his 19 year old scholarship lacrosse playing son had TOS for 5 years. The pain was constant and effecting his personal and professional life. He had been to 4 – 5 neurologists and orthopedic specialists, a few chiropractors and a few physios.

He fractured his collar bone in a game at age 14. He had had symptoms of TOS ever since. What we determined was the fracture of the collar bone was not the cause as it healed up nicely. The rest on the couch leaning back watching TV is what caused the strain on the floor I and floor II muscles to compress the thoracic outlet structures leading to the TOS. After that I learned he would lean back when studying in bed, lean back and to the side when playing playstation xbox and lean back when in the bus on the way to games, lean back when kissing his girlfriend for hours. He would also wear a back pack that would cause compression on his neck and shoulder as well.

However the most compression was coming from his pectoralis minor spasm. His pectoralis minor pulled his shoulder girdle down. This rotated the collar bone down at the end. That caused strain on the clavicular head of the SCM and that was the main source of the pain that drove him nuts. We figured out that holding the xbox, cell phone and mouse was causing this pec minor-scm-scalene chain reaction.

4. The Overnight Bag Mom – A lady came to me with a severe tos on the left. After discussing all the possible ways she could strain the neck and shoulder muscles by reading or watching TV in bed, sitting back in the car, sitting back on the couch we couldn’t find out what it was.

That is when I noticed her purse. It was more like a travel bag. It felt like it weighed 20 pounds. I know when I travel 22 hours to southeast asia with my computer laptop bag I feel a tos coming on.

This can happen with bowling bags, travel bags, back packs, musical instrument bags etc

Below are the rules to a bag or purse:

When the purse is held on the right, the head must lean to the left to counterbalance the weight of the purse and vice versa. You may think that the pressure is on the side of the purse and it is. It would be in level 2 on that side and one and level one on the opposite counter balanced side.

5. The Semi Pro Tennis Player – this man was referred by a vip client. He was told by 3 neuro surgeons he had a herniated disc on the right that was causing the pain shooting 10/10 down his right arm and hand for 3 weeks.

He did have a herniated disc on the MRI but it did not specificially say it was compressing the nerve root. I looked at the MRI  report and it said there was osteophytes which means the disc was an old injury and not likely the cause of his 3 year pain and there was no trauma He said it came on gradually. Herniated discs do not come on gradually. That is how you rule them out.

The one thing that ruled out herniated disc on the nerve root was that his hand was swelling in the morning as he could not get his ring off so easy and his hand felt colder on the left than the right. Both are signs of the vein compressed not letting the blood out so it swelled with blood and the compression of the artery not allowing blood in causing the cold feeling.

So when I did the tests we found out he had tos.

The cause? I asked him all the common bad habits and he had only one which was how his seat was in the car. However he did not drive a lot and did not drive a lot more in the last few weeks so it had to be something else.

What I finally found out was that he got a tennis ball thowing machine to help his clients practice. The problem is that it was not on wheels so he had to grab it with the right hand, lean left with his body and his head and neck straining to the left as he dragged this machine loaded with balls on and off the court many times a day between each lesson.

I suggested he put the tennis ball throwing machine on a flat dolly he got for $20 and push it which he did and after a few days of treatment he no longer needed surgery and was back on the court.


 Read Chapter X – Self Help Treatment for Thoracic Outlet Syndrome


Thoracic Outlet Syndrome Book


 

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Disclaimer

All content on teamdoctorsblog.com, including without limitation text, graphics, images, advertisements, videos, and links (“Content”) are for informational purposes only. The Content is not intended to be a substitute for professional medical treatment, advice, or diagnosis. Please remember to always seek the advice of a qualified physician or health professional with any questions you may have regarding any medical concerns. Dr James Stoxen DC and Team Doctors does not recommend or endorse any specific treatments, physicians, products, opinions, research, tests, or other information it mentions. Said Content is also not intended to be a substitute for professional legal or financial advice. Reliance on any information provided by Team Doctors is solely at your own risk.

About Dr James Stoxen DC (282 Posts)

Dr. James Stoxen, D.C., owns and operates Team Doctors Treatment and Training Center. and Team Doctors Sports Medicine and Anti-aging Products. He has been the meet and team chiropractor at many national and world championships. He has been inducted into the prestigious National Hall of Fame, the Personal Trainers Hall of Fame and appointed to serve on the prestigious, Global Advisory Board of The International Sports Hall of Fame. He is also a member of the Advisory Board for the American Board of Anti-Aging Health Practitioners. Dr. Stoxen is a sought after speaker, internationally having organized and /or given over 1000 live presentations around the world.(full bio)


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