Re: Mike - Stacey re TOS Tests and medicines

[Guest guest]

Right up front it is important to note that neither you nor your

boyfriend are professionally trained in doing these tests and doing

self-tests is just an indication and not to be construed as any form

of actual diagnosis. Having said that, the self-tests can be used as

indicators for things you might want to consider/check into later by

or with your doctor.

Soft tissue conditions/syndromes are not at all like being pregnant

because you can in fact have " just a little bit " of a condition. It

is not a pure black and white, none at all or full blown, situation;

it is more like a sliding scale.

The other thing I need to point out is that while these tests are

standard orthopedic assessment tests, they are not be-all, end-all,

ultimate diagnostic tests used to conclusively nail down either CTS

or TOS, or to identify precise problem areas. To do that, you get

into things like nerve induction tests, arteriography, venography

and other different types of assessment. What they are good for is

a quick assessment to test those aspects that are responsible for a

large percentage of the total. Like police work - round up all the

usual suspects first and throw them in the line-up to see if any of

them get picked. If none of them get picked, then you start looking

elsewhere. But check for the most obvious first.

(Another cover my tush legal disclaimer coming up). By law, the ONLY

health care providers who are ALLOWED to " diagnose " anything are

licensed MDs. Period. Even if I personally conducted the tests on

you, KNEW beyond all shadow of reasonable doubt in my mind that you

had or did not have one of the conditions, all my license allows me

to do is " suggest " that you see your primary care provider for an

actual diagnosis. Even if I KNEW that your primary care provider

was incapable of doing the proper tests, I am still REQUIRED under

the scope of my practice to refer you back. (This disclaimer

provided courtesy of the governing Standard of Care and Scope of

Practice Laws.)

Let's start with the Phalen's test for CTS and what it suggests to

me. The results fell on that sliding scale. You did not get a " no

sensation - nothing there " but then again neither did you get a full

blown " can't hack this at all " sensation. What you got was a median

nerve aggravation/irritation response, at least to some degree. I am

assuming that the tingling and numbness were in the first and middle

fingers. If not, then what I am about to say doesn't apply. What

this suggests is that you do not yet have full blown CTS but you

could become a candidate for it with continued repetitive stress

injury. It also suggests that you might want to start on some kind

of preventative maintenance program now to keep it under control so

it does not turn into CTS.

As for the other four tests, I apologize. After I sent the post I

got thinking " ooops - used big words again that they might not know

the meaning of. " Abduction (ab) means moving away from. Adduction

(add) means moving toward. So, 's Hyperabduction test means

moving the arm away from the body and up. In other words, bring it

slowly from a hanging down position, straight out to the side, and

up pointing toward the ceiling (Jumping Jack motion).

None of the three tests you did do gave positive results. All this

suggests is that those particular muscles tested aren't the

culprits. Have him do 's on you now that I gave a better

explanation of how to do it and see what that shows.

But regardless of test results, I do not like that temperature

differential in your hand and arm. To me, that is a clear indication

of some type of circulatory problem. You need to get it checked.

(In spite of my bad-mouthing " specialists " I will freely admit that

I fall in the same category to a certain extent. I fall into that

category solely because I have to look at things through

the " glasses that I wear. " My basic training is soft-tissue so I

will naturally look at those options/causes/effects. But in my

defense, I also try to look outside my box - and keep trying to make

my box bigger.)

So, what causes a temperature differential? Basically, it is a

reduced circulation, some kind of blockage of blood flow. Normal

blood flow isn't getting to your hand. The questions then become why

not and where is the blockage? The tests I had you do looked for

those obvious, usual suspects. The test results suggest that the

problem lies elsewhere. Because the temperature is coolest at the

hand, less cool at the elbow and warmer still at the shoulder, it

suggests that the blockage might lie someplace between the shoulder

and the elbow. How does the temperature compare, one arm to the

other, by area/region - hand/elbow/shoulder? See if that comparison

gives you any sense of where the blockage might be.

Another thing for you to check/test/think about. Is the temperature

differential constant - is it there all the time? Does it vary by

time of day? Worse in the morning and eases up during the day? Is

it aggravated by having your arm in any particular position, such as

bent at the elbow, raised over your head, etc?

It could be from a muscle impingment compressing an artery against

bone, from entrapment (compressing an artery between adjacent muscle

fibers), from an abnormal routing pinching the artery between two

bones, or an internal obstruction in the artery itself. In other

words, there are a whole raft of possibilities.

But whatever the cause, something ain't right. And you do need to

get it checked out to find out what. I view circulation problems in

the body the same way I do bad brakes and tires on my car - you

don't ignore them in hopes of them getting better on their own.

Let me know if I can help further.