Thoracic outlet syndrome: A straight-forward diagnostic approach

[@danlauramillward2019]

Thank you for this. Not often is the shoulder blade pain mentioned, yet it is my worst and most constant symptom

[@jaymel740]

Hey DR.Happy to see you're back in action.Your videos been helping me alot on learning about my conditions.From New York City

[@MSKNeurology]

Happy to hear that bud

[@Ufcsniper444]

Glad you’re back kjetl. You are the best neurologist I have found on KZbin and just want to help you for all you’ve provided me with.

[@martinhagstrom6707]

Imponerad av dina kunskaper om TOS Kjetil. Har sett dina tidigare videos om TOS samt läst en längre artikel som du skrivit. De är de bästa källorna om TOS som finns på nätet, all amerikansk litteratur inberäknad.

[@MSKNeurology]

Takk, Martin!

[@cubegoose-x5p]

Great stuff. You are one of the few people who truly has understanding of muscular, skeletal, and neurologic dysfunction. Most pts will just say to do shoulder squeezes and stretch for pain, but your strengthening suggestion makes a whole lot more sense. Quick question, who can I see to help me with proper breathing patterns?

[@adityachavan9025]

Are symptoms progressive? Also mild vtos ans atos can be treated with muscle strengthening and posture improvement?

[@LiMitZplus]

Have you done a video on what happens to the lower body in scapular dyskinesia and tos? Ipsilateral Lat tightness ql pain, hip flexor tightness and glute med inhibition

[@ozzy3ml]

You are describing my symptoms here. If you have any good resources on the topic I would really appreciate it! Hopefully Kjetil also has something about it, I only recently discovered this great channel.

[@teresalewin36]

fabulous work, I have seen all your videos, please upload more exercises for the pterygoids if there are great asymmetry of the atm and facial.Greetings from Argentina

[@MSKNeurology]

Not necessary, just do the lateral pterygoid.

[@domhillspt7986]

In terms of adding in the shrugging and scalene work you've mentioned before are there any muscles you recommend need to be backed off on in terms of workouts, like the chest muscles for example?

[@venik88]

What’s the point of knowing if you have TOS if there’s no good therapy for it?

[@marcinniemczyk1380]

what if shrugging with 30 degree abduction make scapula cracking? does it mean serratus anterior is too weak?

[@georginafatharly]

Have you ever seen stretched nerves rather than compressed?

[@theMDMentor]

Excellent video. So true about underdiagnosis due to inadequate testing, especially by those who are not knowledgeable about the pathophysiology. In Canada the radiologists change orders, and do what they feel like doing, ignoring presumptive diagnoses. Two questions. 1) is Nordic walking likely to aggravate TOS? I tried switching to this because doing upper arm exercises with weights while walking definitely made pain worse. 2) Understand and agree about military posture being a bad idea. But would elevating the affected arm (on pillow or armrest) also be likely to aggravate because of scapular position? Would lying flat on the back all night tend to put you in something of a military position and be likely to aggravate on that basis? Thanks for your thoughts and clear explanations.

[@dominichills]

Hey Doc, are there any exercises to avoid like chest, lat pulldowns or others when you have TOS? Thanks.

[@annap1191]

Thanks for the video. I suspect I have the venous type. I have swelling in the peck minor and upper traps and my scalenes are so puffed and now I have pressure on the side of my inner throat its uncomfortable to eat. I have an appointment to see a specialist in 30 days. Are there any major warning signs i need to keep in mind? Will muscle relaxants like Norflex help a little bit?

[@ArisEmriis]

Thanks for posting about your symptoms. I have the same things going on that developed during my first year in recovery, I think from bad posture and hunching while smoking a lot of cigarettes. (I've recently quit smoking) I was starting to get really worried and scared that it was something life threatening but research is showing me that this TOS is the likely culprit. I haven't seen a doctor because I don't have a working vehicle right now. But I'm going to get as educated as possible before I ever see one so I don't end up with the wrong diagnosis and help. Thanks again and I hope your situation is improving.

[@kittypattaya]

Thank you so much for your video! Just wondering can tos also cause right sided facial/scalp numbness? I have this aswell as right sided arm/scapula/chest numbness/ and pain is also only between shoulder blades nowhere else.. and additionally with the selmonsky sign how long should you hold your hands up? Could you get a false positive if you hold your hands up too long? As mine is positive if I hold for 20 seconds however worse on my unaffected left side.. I’m so confused I’m in Australia and having such a hard time figuring out what this is! It’s driving me crazy! Thanks so much for this video ❤❤

[@sarramackenzie-pilot4416]

I have bilateral cervical ribs, left is complete full bone and right is partial. Found after a car accident when I lost feeling in my left arm and pins and needles into the right arm. It has taken a year to get to talk to a surgeon who is even willing to consider TOS. I would have thought the presence of bilateral c7 ribs and an rtc multiple impact injury would have been reason enough to listen to the possibility of TOS. What would you recommend to suggest to the surgical team test wise? I am hopeful the extra bones will be removed, because if my only power is growing unnecessary bones that have the potential to cause impingement, then I am really not that interested in being one of the X men. These mutant bones need shifting.

[@MSKNeurology]

In other words, those cervical ribs were causing no problem prior to accident. Ie., you have whiplash. Tos due to neck whipping.

[@sarramackenzie-pilot4416]

@@MSKNeurology I also managed a torn rotator cuff and 3 bulging discs in my neck too, it was a spectacular crash. Side on impact, he then pushed my car into oncoming traffic for a head on collision, and sped off. 🤣🤣

[@davidcayjohnston4165]

Is strenghtening recommended aswell when the pectoralis minor is involved?

[@danielreznicek7267]

Hi Kjetil, excellent stuff. My question is how do you differentiate whether your problem is caused in the clavicular/pec minor area or down the line, in the elbow area? I have symptoms such as tightness in the armpit, numbness in the last the fingers (ulnar nerve?). How should I approach self-help rehabilitation? Focus on the shoulder area or on triceps work? Thanks!

[@MSKNeurology]

Experience and appropriate clinical workup. Do you expect me to write it all up in a comment? As a guideline you can expect 80+% of the issue to be situated at the costoclavicular and interscalene segments

[@danielreznicek7267]

@@MSKNeurology Of course I do not expect that. I already went to a psysical therapy, where they just massaged my scalenes, and also visited a neurologist, who merely stung my fingers with a needle and said my nerves were working, bye bye. No real help from either of them. So thank you for pointing me in a certain direction with those percentages. Appreciated.

[@MSKNeurology]

They can't help you. read my TOS article and see my videos. I can't and won't do 1 on 1 via comments, consider booking a session@@danielreznicek7267

[@Eddie42707]

I have this issue after years of lifting now I can't bench press because I lost strength and power on my left side. I have to get surgery.

[@tank7162]

Something happened to your TOS article, it now redirects elsewhere. I believe the key points were better neck and shoulder aligment habits and overall postural awareness, scalene strengthening and elevating the clavicle?

[@MSKNeurology]

Some asshole hacked my page. it should be fine now. Thanks for notifying

[@rajivriccardo]

Is strengthening the serratus anterior also helpful for improvement of tos symptoms?

[@MSKNeurology]

It is not that simple

[@jackprot351]

Great video. Great title, too. You should get much more clicks on this one. I think generally your videos don’t get as many views because the terminology you use might intimidate the laymen.

[@MSKNeurology]

I took your advice to heart, thanks

[@Marco-pf3te]

Any advice on dorsal scapular nerve entrapment would be greatly appreciated

[@MSKNeurology]

Either C4-5 or C5-6 root irritation, or TOS

[@debbiehanus5455]

Great videos and articles, I had TOS surgery done a year ago that resolved my anterior neck pain. I work in the physical therapy field and did my own rehab after to gain my full arm strength and ROM back. Recently I started therapy due to symptoms like suprascapular nerve entrapment that the surgery did not address. I was a dancer for many years and have a good posture and very much agree with what you say but the PT kept blaming my posture emphasizing pinching the shoulder blades back and down while giving me neck bend/rot exercise in all directions with a red TeraBand. This cause thumb/index finger numbness/tingling and anterior neck pain I did not experience for a long time, I am considering not going back there

[@alecmcdonald716]

has the numbess and tingling in the thumb and index gotten better... mine did the same with the shoulders back and down yesterday

[@Cody27]

Amazing work. I think a video on numbness would be very beneficial. From my own experience, numbness was a totally hidden struggle. When I had enough trial & error behind me that I was on the recovery path I was AMAZED at how prevalent numbness was and how pain was getting over focused.

[@MSKNeurology]

Doubt you're talking about what I am talking about.

[@AngieMUC]

Did you totally recover without surgery?

[@drmohammadabdurrahim5276]

Nice and informative

[@playermartin286]

According to Dr evan osar TOS is treated through proper rib cage positioning and optimizing your breathing mechanics. What’s your opinion of that?

[@MSKNeurology]

It's not that simple

[@Chieftainteroix]

If I have tight, short pec minor causing TOS type symptoms should I do pec flys to strengthen, avoid bench press to stengthen at end range?

[@MSKNeurology]

Neither. Read my tos article or book a session

[@richardmurphy6244]

On a different note…do you have any experience treating patients with neck issues cause Tinnitus?

[@MSKNeurology]

Yes, read on my website

[@naimismail7768]

Ok I am now 100% sure I have TOS- How do I fix it?

[@MsBoontjie]

Thanks for the video Kjetil! Would the Roos test be positive for ulnar nerve (cyclists) palsy as well?

[@megancasper3525]

Thank you for the information. I have commented before on website but know it’s hard for you to respond to all. I had an emg done and had nerve issue above elbow they said it wasn’t tos, but I feel like I have it because of symptoms you describe. Not sure where to go from here

[@MSKNeurology]

Book a session.

[@megancasper3525]

You take patients from Us? You take insurance?

[@MSKNeurology]

@@megancasper3525 Skype session. No insurance.

[@megancasper3525]

Ok I’ll look on website thanks

[@troppur7355]

My hand pain is ulnar sided. Could it still be TOS?

[@MSKNeurology]

Ulnar pain is the most common early symptom of TOS

[@Ericortega.01]

Hi Dr! When descending my left arm I can feel a "click" with an electric sensation. It's usually just before 90º of shoulder flexion. Do you know what might it be? Thank you! Good job sir

[@MSKNeurology]

Most likely a combination of glenohumeral dysfunction, and your collar bone lying too low (ie. on the plexus)

[@Ericortega.01]

@@MSKNeurology Thanks sir!

[@cintao5656]

Hey, glad to see you back making videos. This is completely off topic but do you think hip dips are reversible with correct posture? Thank you :)

[@MSKNeurology]

Hip dips?

[@moefapie]

Watched a lot of your videos and read you post on the scapula, but one thing that is still a bit unclear, how do you set the scapula in height, angle and against the ribcage before performing any excersize?

[@MSKNeurology]

Book a session

[@moefapie]

@@MSKNeurology didn't know I could do that

[@GigaChad-em9qw]

@@moefapie did you ever find out

[@moefapie]

@@GigaChad-em9qw yes, he has an updated video where he explains in greater detail.

[@GigaChad-em9qw]

@@moefapie can you link please?

[@ZombieTube4u]

What’s your opinion on strengthening the upper traps to help with compression of the upper plexus from TOS?

[@MSKNeurology]

Read my TOS article

[@ZombieTube4u]

@@MSKNeurology don’t tell me what to do

[@theMDMentor]

@@ZombieTube4u Seriously? You ask for free advice and don't like the answer, so you respond rudely. The name suits.

[@zetsu454]

I have this issue where the muscles of the right half of my body are generally weaker than my left and when I am at the gym, I don’t feel the muscle while working out in comparison to the the healthy other side. Also got that thing with right shoulder where it is more rounded and popping forward + when I do rows it pops when elbows are just about going behind body feels like something is pulling it down towards chest + get numbness through while arm through the first 3 fingers of my hand when raising arm with more than 45 degrees away from body and during push up plus .I think it is my pec minor + serratus anterior. What do you think great doctor?

[@MSKNeurology]

Book a session

[@jl12017]

Thank you. Invaluable video

[@bernardoreyes4770]

Thanks for everything man! need to call you soon

[@rubsydos]

i wish u were here in hk..which doctor checks these??

[@MSKNeurology]

Good ones