Thoracic outlet syndrome: Presentation, diagnosis & practical intervention

Reuploading this after some audio editing. Hopefully you will find it easier to listen to, seeing as the initial one had garbage audio.
This is a re-recorded lecture on thoracic outlet syndrome that I initially created for the following medical conferences:
* Malaysian society of interventional pain practitioners - Virtual presentation, August 2021. Thoracic outlet syndrome 101.
* Advanced interventional management of pain - Virtual, October 2020. Thoracic outlet syndrome: Presentation, diagnosis and intervention
Apologies for the bad audio quality, I don't understand why it is so unclear. Either way, enjoy.

[@HN-Anonymous]

My life has changed jsut from keeping my shoulders up and working on my scalenes, just keeping shoulders up makes a HUGE difference, lessened my head pressure, fatigue , neck pain, and weird other symptoms, physicians who deny this illness are fucking stupid like with everything else , they don’t know the cause of anything or the cure, yet they are the drivers of medicine

[@zakazan8561]

Great video, I thankfully do not suffer from this issue, my issues are more lumbopelvic and pudendal, but I appreciate your videos and articles on these subjects and you have a very unique way of looking at things that blends both physiotherapy with neurology, something that no physical therapist I've seen for my various issues has done. Please keep doing what you're doing, you have no idea how much you're helping people suffering from complex issues that don't find relief even from going to multiple doctors, specialists, and physiotherapists

[@abdulrahmankabli47]

Your advice on TOS changed my life. I hope you are aware of how much you helped many people. Also, the audio is good no need to re-upload 👍

[@MSKNeurology]

Thank God my friend

[@jm213213]

2 doctors and 2 chiropractors had no clue what was going on and offered no help. It took an athletic trainer at a school I work at to diagnose it. trying to rehab at home with strength training.

[@jare0056]

What kind of strength training exercises helped you?

[@aiste5934]

Thank you so much, I wish more doctors were aware if this syndrome

[@TOSUnbound]

Not that you were inferring it, but he’s not a doctor.

[@kon-tiki-77]

Good video! Thoughts on ways to go about moving forward a recessed upper jaw that causes: nasaly voice, underbite, congested sinuses, headache, slight speech impediment, and fatigue?

[@MSKNeurology]

Let me know if you find the audio acceptable or not. There is such terrible reverb in my office. I have used AI noise reduction of the Adobe Premiere application and I think it sounds better.

[@Floyd..B]

The quality seems better, thank you for correcting the audio.

[@ResilientME]

You could try running a speech-to-speech AI program to eliminate all room acoustic, albeit some may find the replacement synthetic vocal more taxing. I have severe brain fog and am managing as is.

[@georgek7831]

It’s ok, but could be a bit louder

[@MSKNeurology]

Shit quality is one thing but LOUDNESS can be resolved by simply increasing your volume @@georgek7831

[@MSKNeurology]

I used Adobe Premiere's rendering. Unfortuantely there is impossible reverb in my office. I'll be moving soon, so hopefully that'll fix it. @@ResilientME

[@pallavimehta9445]

I don't have TOS symptoms but I have POTS that started after consuming a pre work drink that had vasodilators but I already had dysautonomic symptoms prior to pots. Body was in sympathetic mode without any emotional stress. Just dont know what caused it.

[@doctorshutup9817]

Very informative my man,, I really do think you're doing some great work in this field and will be recognized for it in the future. I was wondering if I may ask: What do you think is the cause for the clavicle dropping? is it due to the trapezius spasming or something to do with scalene perhaps? Thanks again Kjetil

[@MSKNeurology]

Poor posture and stress

[@Chs3__1234]

Good advice, but i dont know how to stop bracing the diaphragm

[@user-nm8kq5qu8m]

Thanks for the content doc. Audio is fine if I turn the volume up. Similarly to scalene exercise temporarily making a patient with TOS worse, does worsening of symptoms within a couple weeks of starting longus colli and capitis exercises indicate that I should keep doing the exercises for them? And is imaging for those muscles more useful than imaging for TOS? Thinking of booking a session but have not had a neck MRI, only X-ray

[@soniavinodolac3251]

I have VTOS and on blood thinners since 2018 when arm engorged with blood. Have tried physio, massage, osteopath, etc. This is the first I have hear of keeping shoulders up: will try it. Started working at a desk again a few month ago and the TSO symptoms have flared up. I dont want to have the first rip removal surgey suggested to me. Anything else you would recommend? I dont want to be on blood thinners for the rest of my life. Any chance I can completey rid myself of VTOS. Much appreciated.

[@Stoffendous]

Youre the BOSS Kjetil!

[@ryanbullas6406]

Great video, Can a sore/tight hip (maybe the Psoas muscle) on the same side as affected because of the TOS in shoulder, maybe from bad posture? Or working out with TOS and having body imbalance?

[@MSKNeurology]

Irrelevant for this video

[@user-bk2dn7sv7f]

After a year, I was finally diagnosed with ATOS, compression of the subclavian artery. When looking at the MRI, it appears the compression may be due to the pec minor. I do have a 'winged scapula' on the same side, with a shoulder that 'rolls' forward, neck muscles are weak as well. At this time I have opted to hold off on surgery (due to conflicting results I've read) but I find some of the strengthening exercises to bother the shoulder/ AC joint. Your videos have been very informative, and I would greatly appreciate any suggestions (of your videos) that would help work on the scapula without firing up the shoulder or TOS. Thank you!!

[@beatz3279]

Same here. Have u found anything that helped. Im also trying to avoid surgery but becoming disabled from this and no exercise physiology here seems to help the nerve glides they give are useless and make shit worse

[@pearlkally8325]

What is Scalenus strengthen exercises? and Tailbone exercises? Would you please make a video to show us? Thank you so much for your work. We learn so much from your channel. Thank you from Canada

[@georgek7831]

He has a scalene strengthening video on his channel already, search for it ;)

[@jhinchey5120]

I have an occluded left vertebral artery and left ear problems. My ribs on the left side get out of alignment and cause severe back pain. I have high BP and incidentally they found an aneurysm. Its been 15 months and I still have no answers other than “go live your life”. I suspect TOS after reading your article on Pinterest.

[@Michellepuccio]

Ehat about heart pressure, my bp is fine but feeling pressure win heart like blood is flowing down my neck to heart

[@baucasascasas4015]

Brother would u help me?i see ur explanation on scapular diskinesia,it really help me with my bench with should er pain,but i dont get the part when u explain how to do lateral raides with scapular diskinesia

[@MSKNeurology]

Book a session then

[@user-pl4hr4jh4l]

I have TOS symptoms. One shoulder is droopy (working to correct that) but the symptomatic side is my “normal” shoulder. Do you have an opinion on why this is??

[@MSKNeurology]

Elevated first rib. This is why you cannot merely look at the mirror height, but look at the CLEARANCE between the first rib and clavicle

[@ZDraconbornDCB]

Hello Mr. Larsen, how does costochondritis relate to TOS?

[@ababahaja]

Sir.. i was desperate and had tried everything to fix my tmj was seriously contemplating suicide Yesterday i found your video while scrolling randomly and it LITERALLY saved my life. Can't express how grateful i am. Years of tmj pain relieved sinply by protracting the jaw However, i still think it has not healed completely.. i wonder if as time goes by, my disc will return to its normal position and function?

[@Marco-pf3te]

Hey Kjetil! What are your recommendations regarding dumbell pullovers when dealing with TOS? Greeting Marco

[@Mental1205]

Is a low resting heartrate( 45-50 beats) )per minute a contraindication for using propanolo for TOS CVH or is that worry not relevant in your experience?

[@MSKNeurology]

Possibly, not always. Typically what makes the heart rate so low is the high head pressure, and seeing as the prop will reduce head pressure you'll typically see no change in HR on prop, or slight increase in HR due to the vasodilation that accompanies it. Try a low dose during day time and if you feel faint, it might be better to use a bed wedge and deal with the supine pressure that way. This is not medical advice but for educational purposes; talk to your doctor.

[@thomaseliot7664]

Are there any exceptions to the pattern that nTOS at the interscalene triangle always caused by weak scalenes? I might imagine that weightlifters or swimmers could have hypertrophied scalenes which could cause compression.

[@MSKNeurology]

You can follow my advice or your own speculations, it is up to you

[@IHRSAS]

I would consider exercising your scalenes sketchy, since theres an equal to or higher risk of the scalenes being overactive than it being weak, which is proven by the success rates of botox and lidocaine injections within the scalenes. Unless a specialist shows evidence that your scalenes are weak, I'd avoid ot since training the scalenes can further elevate or your first rib or further compress the interscalene triangle

[@Mental1205]

Hello Kjetil! Does increasing reps for scalenes over time(from 2-5 reps within 2;5-3 years 1xweek) entail that the muscles will always heal properly over time? FYi, i always get mild worsening the day after(fullness inside head, more emotional, more tired etc ) whether I do 2 or 5 reps on both sides and wonder if surgery could be the final puzzle piece missing?

[@MSKNeurology]

Use the lowest reppage that causes mild worsening. If you get mild worsening with 2 reps and you stubbornly perform 5 anyway, it's a time bomb

[@Mental1205]

@@MSKNeurology Thanks for your input and efforts in helping patients

[@georgek7831]

Is there a reason why some patients get headaches from this without the symptoms in the arms/shoulders?

[@MSKNeurology]

Most patients have predominantly neurogenic symptoms, many have neuro and vascular symptoms combined, and some just vascular symptoms. It is what it is.

[@alexkelly757]

great question, that's what I get and always wondered why, its made diagnosis a long process and difficult for people to believe.

[@xpost92]

One reason It seems poor posture, severe weakness in the lower cervical and thoracic extensors causes the scalenes to take on extension/stabilisation of the cervical spine. This causes pull on the cervical spine, headaches and migraines. Modern day poor posture has prob increased the rate of this condition significantly

[@scottk1525]

Would be great if you could make a video about correcting loss of cervical lordosis. It's a very common issue.

[@MSKNeurology]

It's caused by neck hinging. See my video on that topic

[@scottk1525]

@@MSKNeurology Thanks. I've seen a few of your vids on it. I've been avoiding the dreaded hinge for about a year now, and have been doing exercises (to include neck flexor exercises) for about 6 months. That said, a recent x-ray shows my cervical spine is still straight as a flag pole. In your experience, is avoiding the hinge and strengthening flexors typically enough to resolve loss of cervical lordosis? Or are other corrective measures often needed? Thanks for all your content. You're one of the very few resources for quality information on this topic, not to mention for corrective measures.

[@MSKNeurology]

Hinging and neck clenching is what causes this problem. Your specific case, what it looks like, how you have performed your correctives, etc., I cannot comment on.@@scottk1525

[@scottk1525]

@@MSKNeurology Understood. Thanks.

[@tara7206]

How can I get. consultation with you?

[@MSKNeurology]

See my website

[@Austin-zn5bq]

"Promo SM"

[@seanl2121]

Do you have to hold your shoulders up forever?

[@MSKNeurology]

yes

[@seanl2121]

@@MSKNeurology how long would it typically take to see results do you think?

[@MSKNeurology]

sometimes fast sometimes not depends on the case, there's no universal answer. I would typically expect fast rather than slow IMPROVEMENT but curation is another topic.@@seanl2121

[@seanl2121]

@@MSKNeurology what do you mean by curation? I have been holding my shoulder up for the past two days and all elbow pain and hand tingling has ceased.

[@akselihe]

Would also be interested in what you consider fast versus slow? 3 months of shoulders up, seeing minor progress month to month 👍🏼

[@user-pl4hr4jh4l]

I have TOS symptoms. One shoulder is droopy (working to correct that) but the symptomatic side is my “normal” shoulder. Do you have an opinion on why this is??

[@MSKNeurology]

Elevated first rib