Do you think that I have Thoracic Outlet Syndrome (TOC)?

Question

I injured my shoulder on 12/23/08 while hitting a tennis serve. I orignally didn't know that I had hurt the shoulder and I didn't feel any pain while I was playing. I 1st felt the pain when I woke up the next morning and it was quite sore. I have played tennis for 8 years and I hit the ball quite hard. Within the last year I have also played volleyball as a hitter and I play the violin quite often. I am 13yro and i am 5'11 large build and athletic and muscular and i weigh approx. 165lbs. I went to 3 doctors to diagnose my case. My symptoms are that the areas around my AC (Acromioclavicular Joint) are quite painful when i use my arm at all and when I am just standing around doing nothing. During the middle of January, I had a purple and swollen and numb/tingling hand. The feeling is hard to explain but my hand felt dead, and since then I cannot flex my hand and i can squeeze half as hard as my other healthy hand. My MRI was as the doctor said, "Not impressive". He said that my actual shoulder injury didn't need surgery but that i need an EMG because the hand problems and the nerve problems were bothering him. I have been going to physical therapy for about 3 weeks now and it is extremely sore after and it is painful and hard to do while I am there. Do you think that it is TOC? And if you do how long do you think that I will be out of sports? Do you think it will require surgery?

Answer 1

Some simple tests for TOS include Roos test, Allens and Adson's test. In Roos test, one puts their arms out to 90 degrees , flexes their elbows to 90 degrees (traffic cop position) and opens and closes their hands for up to 3 minutes. Production of numbness and tingling is considered a positive test.



Allens test involves you putting one arm out to the side at 90 degrees, bending the elbow 90 degrees (traffic cop) and looking away and taking a deep breath and holding for 10 seconds...loss of the pulse in the raised arm (you'lll need a partner to help you with this one) is considered positive.



Adsons test involves simply bringing the arm backward (do not raise it), looking towards the arm and taking a deep breath and holding. Loss of the pulse is considered positive.





The more positive tests you have, the more likely it is you have TOS.



Not all cases of TOS require surgery. If it's due to posture and muscule tightness...possibly reversible by PT. If it's due to a "cervical rib" or vascular occlusion, surgery is usually required.

Answer 2

The thoracic outlet is an opening on the upper end of thoracic bony cage. This outlet lets blood vessels, nerves and some other structures to move from the chest to the arms and the neck (and the head). Sometimes the structures coming out from the outlet can get compressed and give rise to a set of symptoms and signs (syndrome) known as the thoracic outlet syndrome.

Answer 3

thoracic outlet syndrome toc