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@emontalvo55 Hello and welcome to Connect. I do have thoracic outlet syndrome. There is surgery for TOS, but in my case, my surgeon advised against it saying it had only about a 60% success rate. Surgery creates scar tissue which would likely make TOS worse. Some people have an extra cervical rib that can be removed, and sometimes the scalene muscles are removed. What was recommended to me was to do myofascial release therapy which stretches out the overly tight fascia and scar tissue that is causing compression. I am also a cervical spine surgery patient which did create fascial scar tissue very close to the area of TOS involvement. Initially, it did make my TOS worse, and I still have a tight area that connects to my surgical scar on my neck. Here are some links that may be of interest about TOS and our myofascial release discussion which has a lot of informational links in the first few pages. MFR has helped my TOS and my spine condition quite a bit.
https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/
Strolling under the skin ( video that shows living fascia)
https://www.mayoclinic.org/diseases-conditions/thoracic-outlet-syndrome/symptoms-causes/syc-20353988
https://www.painscience.com/articles/respiration-connection.php
https://www.hindawi.com/journals/scientifica/2014/248163/
https://mskneurology.com/how-truly-treat-thoracic-outlet-syndrome/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4240700/
https://www.jospt.org/doi/pdf/10.2519/jospt.1979.1.2.89
TOS is often missed and misdiagnosed. Did you have a TOS diagnosis form a specialist? Have you tried physical therapy for TOS? Had you heard on myofascial release before?
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I found this on facebook from Kjetil Larsen, the physical therapist owner of mskneurology.com who writes extensive articles about physical issues. I often share his articles here on Connect.
He wrote this about Thoracic Outlet Syndrome and chronic fatigue and migraines
"Idiopathic chronic fatigue is a common symptom of undiagonsed craniovascular congestion. There are three main mechanisms:
1. Severe craniovenous outlet obstruction results in both venous and arterial hypertension and congestion. When a sufficient amount of blood is prevented from exiting the head, borderline hypoxia will occur, resulting in fatigue, brain fog, impaired memory, loss of motivation, etc.
2. Cranioarterial hyperperfusion (as seen in TOS, perhaps one of the most common culprits of "idiopathic" chronic fatigue) results in secondary systemic hypovolemia due to induced bradycardia and peripheral vasodilation, ie. a condition where systemic pressures reduce to alleviate the high head pressures. This, although ameliorating the head symptoms, will cause a paradoxical adrenal upregulation, as the body is unable to exert significant force in a hypovolemic, hypotensive state. This results in adrenal exhaustion, severe fatigue, brain fog, depression, immune suppression, and often very high propensity to infections. Also, migraines, dizziness, visual dysfunction, etc.
3. Very high stress / anxiety / OCD / uncontrolled drive. Patients who are very tense, practically walking around with a constant valsalvsa maneuver, develop very high but intermittent blood pressures. This raises central venous- as well as arterial pressures intermittently, often worsening in parallel with the degree of psychiatric illness. Also tends to severely upregulate sympathetic and adrenal activity. This is often seen in conjunction with #1-2, but all of the three problems. Thus, a biopsychosocial angle of attack is often necessary.
I recommend the following preliminary exams: MRI head and neck, CTA head or MRA MRV head, high quality fundus exam, thoracic angiogram with arms neutral, up, and shoulders back and down. Proper physical exams must also be done."