Thoracic Outlet Syndrom

You Docs: Face-plumping fillers for the feet spell relief

Q I am young, 5 feet 6 inches tall, weigh 129 pounds and don’t have diabetes. But because of unlucky genes, I have severe atrophy of the plantar fat pads on my feet. You can see the bones of my feet pressing against my skin. Podiatrists tell me there’s no treatment other than custom orthotics and shoes. They’re not working. I have read about injecting fat and using “GraftJackets.” Do they work?

A: There’s a lot of interest in (and advertising about) fat grafting these days because the aging population is facing a serious fat-vanishing act. Not from our waists (if only!), but from our faces and, oddly, the balls of our feet, where fat acts as a shock absorber.

Fat grafting sounds like a neat solution to your problem: Your doctor takes fat from elsewhere on your body and grafts it onto your feet. With a little help from a type of biologic scaffolding called GraftJacket (made from donated skin), your body builds new tissue to replace the missing fat. GraftJacket helps heal diabetic foot ulcers and injured tendons, but it hasn’t been widely used for your problem.

Some docs are trying a less-complicated procedure: injecting silicone, collagen or other fillers into feet. Yes, it’s the same stuff that’s used to plump up wrinkles in faces. It’s expensive and must be repeated often. Still, combined with custom orthotics, it might ease your pain and get you back on your feet.

Q: A 67-year-old friend has allergies, asthma and COPD. Should he take N-acetyl cysteine and, if so, how much?

A: Dr. Mike prescribes about 1,200 mg a day of N-acetyl cysteine to many of his patients with chronic obstructive pulmonary disease, a lung condition that steals your breath. It’s comprised of chronic bronchitis, emphysema or both — and usually gets a nasty nudge from smoking.

Your body uses NAC to make glutathione, a major antioxidant that helps prevent lung damage and gives your immune system a healthy goose. While the evidence on NAC isn’t clear-cut, several studies show that taking 400 to 1,200 mg daily for three to six months reduces bronchitis attacks in people with COPD. We also think that NAC reduces inflammation.

Even though NAC appears to have no side effects, your friend should talk to his doctor before taking it, and should get his levels of inflammation-quelling vitamin D-3 tested, too. If it’s low, D-3 supplements are in order (we usually recommend 1,000 IU a day; 1,200 after age 60).

Thoracic Outlet Syndrome | WasWatching.com

What is Thoracic Outlet Syndrome?

 TOS is an umbrella term that encompasses three related syndromes that cause pain in the arm, shoulder, and neck:  neurogenic TOS (caused by compression of the brachial plexus), vascular TOS (caused by compression of the subclavian artery or vein) and nonspecific or disputed TOS (in which the pain is from unexplained causes).  Occasionally, neurogenic TOS and vascular TOS co-exist in the same person.  Most doctors agree that TOS is caused by compression of the brachial plexus or subclavian vessels as they pass through narrow passageways leading from the base of the neck to the armpit and arm, but there is considerable disagreement about its diagnosis and treatment.

Making the diagnosis of TOS even more difficult is that a number of disorders feature symptoms similar to those of TOS, including rotator cuff injuries, cervical disc disorders, fibromyalgia, multiple sclerosis, complex regional pain syndrome, and tumors of the syrinx or spinal cord.  The disorder can sometimes be diagnosed in a physical exam by tenderness in the supraclavicular area, weakness and/or a “pins and needles” feeling when elevating the hands, weakness in the fifth (“little”) finger, and paleness in the palm of one or both hands when the individual raises them above the shoulders, with the fingers pointing to the ceiling.  Symptoms of TOS vary depending on the type.

           Neurogenic TOS has a characteristic sign, called the Gilliatt-Sumner hand, in which there is severe wasting in the fleshy base of the thumb.  There may be numbness along the underside of the hand and forearm, or dull aching pain in the neck, shoulder, and armpit. 

          Vascular TOS features pallor, a weak or absent pulse in the affected arm, which also may be cool to the touch and appear paler than the unaffected arm.  Symptoms may include numbness, tingling, aching, and heaviness. 

            Non-specific TOS   most prominently features a dull, aching pain in the neck, shoulder, and armpit that gets worse with activity.  Non-specific TOS is frequently triggered by a traumatic event such as a car accident or a work related injury.  It also occurs in athletes, including weight lifters, swimmers, tennis players, and baseball pitchers. 

TOS is more common in women.  The onset of symptoms usually occurs between 20 and 50 years of age.  Doctors usually recommend nerve conduction studies, electromyography, or imaging studies to confirm or rule out a diagnosis of TOS.

Kompaktwissen Gefachirurgie, Differenzierte Diagnostik Und Therapie

Angiologie, stratégie du diagnostic et de la thérapeutics

Medical infrared imaging

Evoked potentials in clinical medicine

Medifocus Guidebook On: Thoracic Outlet Syndrome