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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Are The Symptoms And Cure Of Neurogenic TOS

My chiropractor has told me I have a couple of extra cervical ribs. I type for a living (33 yrs now) and my arms and hands are so cold every day that I need a space heater by my desk to warm them up as I work. My left index finger and baby finger go numb and my right thumb and index finger go numb, but most of the time all of my fingers are cold. It s hard to keep track what does what now. I also get awful headache pain in the back of my neck and need to put ice on it immediately until pain subsides. I have also had alot of head/neck trauma. Do u think I may have neurogenic TOS? What would the treatment be?
Mon, 23 Apr 2012
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Vascular Surgeon,  's  Response
Hi Debbiie,
You are exactly right. You have 'Neurogenic Thoracic outlet syndrome(n TOS)". From your description of symptoms you have the following factors in favour of the diagnosis of TOS.
1. You do typing work- that very important job related risk factor.
2.You have been told by somebody to have extra ribs.
3.You have had trauma in neck and shoulder previously- which brings to notice or agravates the symptoms of cervical ribs.
4.You have numbness and feeling of cold in both sides of your hands.
5.You have headache frequently.
All of the above go in favour of neurogenic Thoracic Outlet Syndrome.
Now for confirm diagnosis ,you need to get a cervical spine Xray and CT/MRI scan if needed later on.
A few clinical tests also can help in diagnosis. Best would be to consult your vascular specialist .
In case of a confirmed TOS, you will be benefited by Physiotherapy. Arround 70-80 % of patients do well with a 6 month physiotherapy training.
And only in case of failure of physiotherapy trial , you may need surgical decompression of TOS,that is excision of the extra(Cervical rib) rib and neurolysis for brachia plexus.
Hope you are satisfied with answer.
Regards,
Dr Srujal Shah
Vascular surgeon.
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What Are The Symptoms And Cure Of Neurogenic TOS

Hi Debbiie, You are exactly right. You have Neurogenic Thoracic outlet syndrome(n TOS) . From your description of symptoms you have the following factors in favour of the diagnosis of TOS. 1. You do typing work- that very important job related risk factor. 2.You have been told by somebody to have extra ribs. 3.You have had trauma in neck and shoulder previously- which brings to notice or agravates the symptoms of cervical ribs. 4.You have numbness and feeling of cold in both sides of your hands. 5.You have headache frequently. All of the above go in favour of neurogenic Thoracic Outlet Syndrome. Now for confirm diagnosis ,you need to get a cervical spine Xray and CT/MRI scan if needed later on. A few clinical tests also can help in diagnosis. Best would be to consult your vascular specialist . In case of a confirmed TOS, you will be benefited by Physiotherapy. Arround 70-80 % of patients do well with a 6 month physiotherapy training. And only in case of failure of physiotherapy trial , you may need surgical decompression of TOS,that is excision of the extra(Cervical rib) rib and neurolysis for brachia plexus. Hope you are satisfied with answer. Regards, Dr Srujal Shah Vascular surgeon.