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Helen asked...

I have been diagnosed with thoracic outlet syndrome...

I have been diagnosed with thoracic outlet syndrome, and had negative nerve conduction tests which is good, but I'm aware it doesn't mean I don't have TOS.

My consultant says there is a 'tension and a migrainous component', but I don't really understand what he means - I only have headaches rarely, when the muscle spasm goes really high up my neck, and not really at any other time. Most of my pain is in my shoulder, arm and back.

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The answer

Dear Helen,

Thank you for contacting us here at Ask the Expert and I’m sorry to hear of the problems you are having.

You are quite correct that negative nerve conduction studies don’t exclude the existence of Thoracic Outlet Syndrome and in fact are a common finding in people suffering from TOS. This is one of the reasons why it is known as being quite challenging for clinicians to diagnose alongside its varying presentation in individuals and the lack of a precise test to establish its presence. The migrainous and tension component your consultant has referred to are likely to be arising from the condition and its effect on your upper muscles but may also be contributing to some of the symptoms you are experiencing which is why he has referred to it.

When performing diagnostics for neurogenic (nerve related) TOS close attention is given to the history of symptoms, pattern, and type that you have been experiencing alongside a thorough physical and clinical examination.

In your case by mentioning the headaches and tension component your consultant is likely to be referring to the element of your symptoms that are making part of the whole picture of what is wrong. It’s unlikely that he was attributing all of your presentation to this and the use of the word component when describing the headaches and tension suggest that he is not, I do hope this will be of help and I wish you the best of luck.

Answered by Health at Hand nurses.


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