Thank you both, and Dr. Lum, for your incredible guidance and support. I truly appreciate you taking the time out of your personal time to answer my questions so patiently. Your expertise is invaluable. While I still need to do more research before making a decision about surgery, I would wholeheartedly recommend you to anyone considering this path.

I get botox in my masseter muscles to treat my TMJ pain. I've done this for 6 years and it's great. I have tons of pain in my scalene muscles on the side where my TMJ pain is the worst. When I get massages there, my jaw tension releases and my arm goes numb. I want to try botox in my scalene muscles. What kind of doctor do I go to for a consultation for this treatment?

I was recently diagnosed with Paget Schroetter (July 3rd 2024). It has been devastating for me since my life revolves around being a rock climber and athlete. I had a DVT and 3 PE emerge seemingly out of no where. I was at Stanford for 4 days where they did thrombloysis and angioplasty & now my DVT is cleared. Got a consultation for FRR. Although I am most likely going to get surgery I am first reading a lot about conservative treatment. From reading some contemporary reports/data (TOS Book 2021 Illig and co) it seems as though some patients with VTOS do just as well with anticoagulation and thrombolysis without FRR. I am wondering if high-res imaging can help delineate with structures that are actually compressing subclavian vein? Seems like many surgeons have a cookie cutter approach and remove scalenes, costoclavicular and subclavius without first trying to understand which specific structures are doing the compressing. It also seems like many surgeons aren't selective and rather than trying to understand patients natural history they just automatically suggest surgery. I hope I can get some more data on myself on my anatomical features, chronicity/acuteness, and thrombophilic states before have a surgeon alter my anatomy forever. This way I can no there was absolutely know other way for me before surgery.

The coughing and background noises make it hard to listen to.. Good info, though..

Hey,I have tos for more than a year and a half and my hands always hurt and recently my arms,shoulder and hands tremor,plus sometimes the color of my hands look weird like not enought blood or nerve damage.What does that mean and what can I do thanks

It took me 10 years to get surgery. I had atrophy within 6 months of symptoms and lost dexterity in my pinky and ring finger. Getting a diagnosis took years. Then my surgeon made me do 3 rounds of botox which my insurance wouldnt cover and fought me which drew things out longer. If i had just gotten my surgey sooner but no took my atrophy seriously i feel like. My pain is greatly reduced but my hand is still lacking dexterity and the atrophy never recovered. Why couldnt they have diagnosed me faster?!

Is it possible that after vTOS decompression surgery the brachial plexus gets shorter? Went through the surgery (rib resection and scalenectomy) and I have continuous increased tension in the plexus on the surgery side. Is this likely scar tissue or entrapments in the shoulder/pectoralis minor? How should this increased tension in plexus (visible in the neck) be treated?

I really hope you get more PCP's, Family practitioners and other various specialists aware of this condition. I've been dealing with NTOS since 2017 roughly. I had my trifecta surgery back in 2022. I'm still really messed up and live and breathe pain everyday. No doctor will touch me, not even for a physical. I can't get any kind of medical help and I don't understand why. The most I've been told is my condition is rare and complex and no one will touch it. I think I might have developed CRPS because my chest gets a burning sensation these days. Sometimes, during a flare up, I will be in so much pain I get dizzy and lose consciousness. Typing and texting hurts, sorry for long paragraph and typos.

Dr Werden, u have a deep knowledge of your expertise. ❤

صح لسانك

I was wondering why I’ve been experiencing intermittent numbness and tingling in my feet and toes. I have bilateral neurogenic TOS.

I would also like to add, that being a hair stylist is highly underrated and not talked about very much. I have had TOS since I was 11. I’ve seen countless doctors and I was a hair stylist for almost 15 years which I believe made my symptoms so much worse. Constant overhead movement while holding tools.

Hi, I have been diagnosed by Dr. Fleischlag in NC with NTOS. I am glad I found your KZbin. I am set for surgery June 24. I think a helpful video would be a video explaining this to our families who really haven’t done the hours upon hours of research that all of us who have been diagnosed have done. Thank you for what you’re doing.

Have you ever heard of cerebrovascular hyperfusion from arterial tos? I have severe cognition and vision changes that directly correlate with the amount of subclavian artery compression. I also have bruised looking bags under eyes that go down my cheek a bit when compression is bad enough. There is a medical paper called " Does thoracic outlet syndrome cause cerebrovascular hyperperfusion? Diagnostic markers for occult craniovascular congestion" Kjetil Larsen is one of the authors and everything lines up with what I have been experiencing.

Can Snapping Scapula contribute to TOS?

🙂 'promosm'

Wow, this doctor is fantastic. I went to a neurologist amongst others and told him my sports physio said he thought I had TOS. I have been complaining about scapula, chest , neck pain for the past almost 6 years. All he did recently was squeeze my fingers, checked for muscular weakness etc etc.. when this first started almost 6 years ago it wasn’t as bad. I kept asking(neuro) to also check my scapula. My issues are only left sided. I had even circled w/a black magic marker the areas I was talking about. He basically was useless. Dr Newkirk is 100% correct, doctors only see through the lenses of their specialty which is really bad for the suffering patient. Hoping this doctor still is practicing b/c I seriously am thinking of scheduling an appt.

My dr is absolutely against surgery. She says it only makes matters worse. I am confused.😢

what do we do about the leg

Can I get tos from having heart catheter done through the wrist? My arm was stretched out and i felt a massive burning sensation in my shoulder while the procedure was happening. While in the recovery room i noticed what i now know is ulnar neuropathy. Months later i started getting pain throughout my hand, inside of my elbow, my thumb which has numerous issues now other than pain. I get pain in my outer shoulder when using it. Due to insurance not working for me im not able to get proper care to find out whats wrong with me. Do you think tos could be my problem? Thanks for any info you might be able to share

All of these comments are me :(

I know this is old but im hoping you see it. I was born with extra cervical ribs (bilateral). They are very high at the base of my neck. The vascular surgeon said physical therapy wouldn't help but we had to jump through hoops for insurance but ever since my second appointment my heart keeps racing. 120 beats per minute. They want to correct my posture first but when i stand up straight and correctly, it makes my heart race. I haven't had an mri of my back and something in the middle feels disconnected. I feel scared that something is wrong but my doctor nor physical therapist will take it seriously. What do i do?

Good to know. I have a car crash into me from behind, whilst I was stationary. I have a sternoclavicular joint dislocation posterior, a fracture on the clavicle and it dislocated from the AC. I have a smashed first rib it has a osteophyte growing in to the chest. The first rib is separated at the costal vertebra, nerves compressed at T5, 6, 7, 8 roots, T1 as well. That’s just the right hand side. The left sternoclavicular joint has ligament tear and same spread from the nerves. This caused multiple embolic strokes, ignored by the hospital, ignored by the doctors and the pain has been absolutely horrific along with dizziness. The stroke went in the back and hit the frontal lobe so I have problems with my impulse control, it’s getting better. Thanks for this video, I could have presented this video including the neurogenic symptoms. Love the video this is one of the best I have watch. Thanks gents.

Thank you for ALL of your videos on TOS!!! I have learned recently that I have this, and am awaiting a much anticipated appointment with a vascular surgeon. Your education on this condition through your videos is helpful beyond words!! Understanding the anatomy greatly assists in trying not to aggravate things further until I know exactly what I'm up against with this. I get so excited to watch your videos, and just so happened to get to be the first to click the "like" button on this one...oddly satisfying haha! 😂👍

thank you for all your information..I am of the very rare stroke patients. 11 years ago I woke deaf dizzy and listening to a roaring on the affected ear. I will be sharing this video.

I fell on ceramic tile and Porcelain in 2014. Even typing on my phone causes the right side of my neck, pectoral, AC joint, and anterior deltoid to tighten up so bad, I have stop everything and just sit and breathe, hoping the tightness eases up.

Thank you so much for your work!

Keep making shorter videos like this as well ! 👏🏼👏🏼

TOS what a pain! Thank you immensely for this great discussion. May I please know Dr. Vernon Williams specialty and his office location in LA? I was diagnosed with neurogenic TOS in spring of 2005 post acromion ectomy on 2 Dec 2004. I am a book smart about anatomy and physiology, I questioned the ortho surgeon if my "LTN or phrenic" nerves were nipped since I also have winged scapulae), he smirked, long and behold long thoracic nerve does affects TOS. Unfortunately, I have many surgeries that started in 2005, 2006, 2007, 2012, 2013, 2015, 2017, 2019, and most recent was 2/13/2024 that required stent. I even had a spinal cord stimulator implant in 4/2007 to alleviate my chronic pain and was extracted on 1 June 2015 due to death of its internal battery in 2011.

Is injecting steroid or lidocaine done under ultrasound helpful for diagnosis?

How do we get the vest?

Can it cos a flaring of the rib on effected side such as 7,8 rib

I want to hug you Doc...wisdom is everything ❤

This Doc is like speaking my life over past four years at least. I need to have him give me a referral for Los Angeles area, or do me a telemed appointment, my shoulders are just like that. Its really noticeable in my breast.

Wonderful discussion and many useful pearls - thank you!

Thank you for sharing and the excellent questions

Had ffr surgery both sides but still have lower back said to need core strengthening and foot problems awaiting scans maybe injections ?

Thank you for this opportunity and excellent video or show about TOS. I have heard of Dr. Lam from my research, but it was just impossible to see him financially. I was diagnosed with all 3 types of TOS in 2005 from UCLA at Gonda, I have flare ups and it is atrociously painful. I was a typist with bad posture. Did have all the surgeries mentioned here. I am now seen by one of the vascular surgeon at Vascular Surgery Associates, 1082 Glendon Ave, LA Another specialist in Santa Monica is Dr. Sheldon Jordan, doesn’t accept health insurance. Thank you for your service.

Lots of background noise: breathing, sniffeling, coughing, rustling.

I’ve read on so many articles TOS can cause tachycardia. Is this true?

Another great talk, Dr. Werden!

Headaches are very common in TOS.

So thoracic out let syndrome Could be other possibility

There’s only one way to pull out a dent… from the inside… Hint: positional breathing

i had a fall from a ladder and broke my fall with my left arm. a week later i had numbness, weakness in my thumb, and a lot of pain. no one ever even mentioned TOS when i was being diagnosed. they just assumed it was my neck vertebrae. i had a triple cervical fusion last June because my cervical spine specialist said i had bulged disks and bone spurs, but my 4th/5th fingers are still numb and my thumb is so weak that my muscle between thumb and first finger has wasted away. it's concave there instead of convex. will this ever come back if i get proper treatment for TOS? i have my doubts at this point. it might be too late.

Would somebody please tell this guy to use an Ethernet cable when making real-time communication? His signal keeps breaking up.

I had TOS and at one point I had spontaneous excess sweating just sitting it was crazy. All these crazy symptoms. No discolouration though

Hi, I have just recently by cat scan been diagnosed with bilateral venus TOS I still have not seen a vascular surgeon. What testing will I need besides the CT and what are the chances I will need surgery and is their many people who have had the surgery on both left and rite side for V TOS?

Any doctor referring patients to Dr. G. James Avery needs to be critically questioned.

Fascia connects your entire body to help you move. Many surgeons compartmentalize your body and believe you can just cut out muscle and bone without impairing movement in the entire body. Once you Cut out your scalenes.. and 1st rib as in Avery’s TOS surgery, you Will scar down!! There is No predicting How you will scar down- but because he is exposing the brachial plexus and nerve roots ... you can end up in Huge trouble. Please work with physical therapists who understand connective tissue, fascia and whole body movement. Please do not believe a surgeon, like Avery can fix you, especially after his track record with patients like me. I don’t believe he understands or cares about the suffering of his harmful patient outcomes- especially after how he abused and treated me.