Among the most common types
of nerve entrapment is Thoracic Outlet Syndrome (TOS)
causing pain and weakness in the neck, shoulder, arm
and hand.
Although all physicians understand
the role of the spine problems in causing shoulder
and arm pain, there is a great deal of controversy
and confusion regarding the diagnosis of thoracic
outlet syndrome. Nerve entrapment of the median nerve
in the wrist at the carpal tunnel can affect the thumb
and next two fingers - carpal tunnel syndrome. Entrapment
of the ulnar nerve at the elbow is cubital tunnel
syndrome. However between the spine and the elbow
there are many nerves, crossing a long course when
these nerves become entrapped or injured, the diagnosis
may be TOS.
Thoracic outlet syndrome can
affect the blood vessels, or the nerves or both. In
the past, it has been easy to diagnose TOS affecting
thed blood vessels - causing loss of blood flow when
the arms are raised. However, diagnostic proof of
TOS affecting the nerves has been considered unsatisfactory
or very difficult to achieve. Now, the advent of MR
Neurography and Open MR guided injections has revolutionized
diagnosis and treatment in this field. With these
techniques, Dr. Filler at the Institute for Nerve
Medicine has shown that TOS can be divided into as
many as six different types of nerve entrapment. Each
of these can be reliably and confidently identified
and new, minimally invasive treatments are now avaiable
for each of these.
In the past, the only surgery
widely offered for the treatment of TOS was resection
of the first rib. This is a very invasive and difficult
operation with an extended recovery period and a very
significant risk of major injury to blood vessels,
nerves or lung during the operation. Dr. Filler has
shown that if the inidividual type of TOS affecting
a patient is known in advance, then it is usually
possible to plan a small, safe minimally invasive
surgery to correct the problem - usually on an outpatient
basis.
There are many diagnoses and
treatments of thoracic outlet syndrome. Please click
on any of the links below to learn more about individualized
cases from the files of Dr. Filler.
