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Prolotherapy: An Alternative to Thoracic Spine Surgery
Ross Hauser, M.D.
The thoracic outlet consists of the space between the inferior border of the
clavicle and the upper border of the first rib. The subclavian artery,
subclavian vein, and brachial plexus nerves (the nerves to the arm) exit the
neck region and go into the arm via this space. In Thoracic Outlet Syndrome (TOS),
the space is, presumably, narrowed, causing a compression of these structures.
The symptoms of TOS include: pain in the neck,
shoulder, and arm; coldness in
the hand; and numbness in the arm and hand. However, in severe cases of
compression of the subclavian vessels, Raynaud’s phenomenon, claudication,
thrombosis, and edema can occur in the involved extremity.
TOS is a legitimate condition and does occur but its prevalence is extremely
rare! Most people who come to
Caring Medical,
in Oak Park, Illinois, with the diagnosis of TOS leave with other diagnoses such
as
glenohumeral
ligament sprain, rotator cuff tendinopathy, cervical ligament sprain, or
Slipping Rib Syndrome.
All of the pain and numbness symptoms of TOS can occur from these later four
conditions, all of which respond beautifully to
Prolotherapy.
The reason it makes sense that Prolotherapy would be BENEFICIAL for the symptoms
of so-called "TOS" is the fact that the condition almost exclusively occurs in
women with long necks and low-set droopy shoulders. Activities that involve
abduction of the shoulders, such as combing the hair, painting walls, and
hanging pictures, cause worsening of the symptoms. Passively abducting the arm
(having someone do it for the person) relieves the symptoms. In other words,
when the
shoulder is actively raised over the head (the person does it
themselves) the symptoms of pain and/or numbness down the arms occur, however,
when the exact same movement is done passively (by another person) the symptoms
do not occur. This type of symptomatology is a perfect description of ligament
and
tendon weakness (laxity). The injured ligament and tendon give localized
and referral pain when doing strenuous movements, but when someone else takes
the brunt of the force, no such symptoms occur.
"The doctor said I have Thoracic Outlet Syndrome and I need surgery to
give the nerves more room.” The people with so-called TOS almost unanimously
have normal reflexes and nerve conduction studies. This gives further indication
that a nerve is not getting pinched. Furthermore, surgically slicing structures
to give the nerve more room will not eliminate the symptoms the person is having
and could, quite possibly, cause more problems. In my opinion, the person needs
Prolotherapy to the pain-producing structure(s), Prolotherapy to the neck
ligaments, shoulder ligaments and tendons, or to a rib that is slipping.
Fusion operations supposedly stabilize unstable segments. So if a person gets a
fusion operation at say T2-T4, the segments above and below this level are prone
to getting advanced degenerative
arthritis because all of the movement in this
area of the spine have to come from there (because T2-T4 can't move). For people
who have been proposed a thoracic spine surgery option,
Prolotherapy should be looked into.
Typically people who have herniated discs or degenerated discs in the thoracic
spine do not have life-threatening conditions or impending spinal cord injury.
For these folks,
Prolotherapy can help reduce or eliminate their pain without surgery.
Prolotherapy by getting at the root cause of the condition, helps eliminate
their pain. For those who have spinal cord injury or other signs of nerve
irritation surgery may be the only option.
Typically the pain in the thoracic spine is coming from a weakened ligament that
allows subluxation of the thoracic spine or subluxation of a rib that attaches
to the thoracic spine. The later condition is also known as slipping rib
syndrome. Surely chiropractic
manipulation can be tried and if the condition
recurs, an evaluation by a
Prolotherapy doctor is warranted. Typically about six
sessions of
Prolotherapy are warranted. The thoracic spine often heals slower than other
areas of the body because it is never at rest. Even during
sleep the thoracic
spine continues to move, so it heals slower even with
Prolotherapy. Typically 3 to 6 sessions of
Prolotherapy are needed, but for thoracic spine conditions it is more like
5-8 session.
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Prolotherapy is a medical
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