@birdman518 Hi Mitch. It sounds like your surgeon is not familiar with TOS, and if he were to acknowledge the possibility of TOS, he would be acknowledging that he missed it when he diagnosed you. I would guess he wouldn't want to admit he missed something especially when it has overlapping symptoms with the spine condition you did have affecting the same nerves, but in different places. I had that problem too with a surgeon who missed TOS, and it didn't go well when I pointed out the mistake. Surgeons never want to make mistakes let alone admit that to a patient. These are things he should have ruled out as a differential diagnoses so he could say with authority that your symptoms were spine related before doing surgery. That being said, your imaging clearly showed stenosis that is definitive for problems of nerve compression, and with overlapping symptoms both of these issues can contribute to the whole problem.

What you describe is consistent with thoracic outlet syndrome in that raising your arms and the same degree of this when laying down brings on symptoms. Rotating your hand is flossing the nerves in those positions. Posture is really important for TOS. What happens with me is I over use my traps raising my shoulder and my shoulder blade muscles are not doing their job keeping the shoulder pulled back where it should be, so my shoulder rotates forward as a "normal " position for me. My PT is having me do exercises to pull the shoulder back and downward. Take a look at your standing posture in a mirror from the side. Your shoulder should be directly under your neck; not forward. Is your head in a forward position or can you hold your neck in a vertical position? I see my husband do this of slouching forward with a forward head position which I describe as looking a bit like a turtle with its neck sticking out.

You may have more luck approaching a neurologist or a thoracic vascular surgeon for a diagnosis of TOS and/or getting a script for PT. They probably would still defer to your spine surgeon to say that PT is safe for you at this time during post surgical healing. I would pick one at a different facility who doesn't know your surgeon because they probably would not want to challenge a diagnosis if they work with your surgeon, and I would ask if they have worked with a lot of TOS patients and saying that you think you need to be tested for this. 4 months is a normal time to begin PT after spine surgery if you have a fusion that has begun fusing, and that is when I started PT after my spine surgery. Can you do some things to stretch the front of your chest? With TOS this gets too tight. I use a foam roller and lay on it on my back (you can find them online.) I don't know about your abilities or what you can safely do, so it's your call, and as always, check with a medical professional. You can also stretch one side at a time on a bed or couch and just let the weight of your arm stretch off the side. Myofascial release may help too anyway. Sure, your nerves need to heal, and any compression of them in other places is not going to help.

Can you find a medical facility that lists TOS as a condition that they treat? You can probably find a specialist there.