TOS

A Guitarist's Overuse Injury: 
Thoracic Outlet Syndrome

Elizabeth Day Lawrence

The aim of this page is to share my personal experience with overuse injuries and TOS, including:


  • Onset of symptoms
  • Conventional Medical Treatment (leading to surgery)
  • Alternative Treatments (avoiding surgery in any way possible)
  • Surgical Outcome


I hope that sharing my experience may be of use to others who are facing similar hardships*

*Written in late 2018

My Risk Factors/Pre-Incident Indicators: 

-Small frame/skeletal structure (?)

-17+ years of dedication to practice, beginning in childhood.

-12+ years of professional career.

-Heavy workload

-High stress, high pressure work environments and failure to utilize diversified coping mechanisms outside of playing the guitar.

-Long hours gigging and practicing 
-Lack of an exercise regimen to balance the musculoskeletal system

-Lack of attention to whole body health and physical dispositions while playing 

-Perfectionistic tendencies (self-critical mindset)

-I did not have an extra cervical rib, but this would contribute to high risk factor 


Onset of Symptoms:

-Sharp, painful muscle cramps in left palm

-Slight loss of coordination in left hand, and dis-ease while playing

-Sore left chest, shoulder, and back. (I initially thought this was caused by the guitar strap). 

-Onset event: Sudden and acute pain, cramps, and inability to use left hand/fingers after extended exertion, in the 4th hour of a 5 hour gig. (A 5 hour gig without breaks is not a good idea!)


This onset lead to a progressive worsening of neurogenic and vascular symptoms: 


  • Chronic pain in left hand
  • Muscular cramping in left hand
  • Left hand "stuck" in a semi-closed fist position
  • Numbness and cold sensations throughout left hand and arm
  • Blue discoloration of the left fingertips
  • Shooting nerve pains throughout left arm, hand, and fingers
  • Muscle aches, dull pain, and strong discomfort throughout left side: shoulder blade, chest, and arm


These symptoms lead to a long journey of tests and treatments seeking a medical diagnosis and treatment for my symptoms. The amount of time between my onset of symptoms and a final surgical decision took almost 2 years. 

Getting diagnosed (unofficially)

began with PT:

The first time TOS was mentioned to me, was by a physical therapist. He casually diagnosed me after noting my symptoms, and how my body reacted to certain stretches and positions. When the assigned PT exercises were initially successful, this further evidenced that TOS may be my problem.


PT was a wonderful solution for me initially, but after some time passed, it was apparent that my condition wasn't stabilizing long term.


Eventually, my symptoms were chronic and unresponsive to any amount of PT. 

 

Official medical diagnosis,

conventional testing & treatment 

(leading to surgery):

This may be changing with advances in medical technology, but in 2017, to get a medical diagnosis of TOS requires the process of eliminating all other potential conditions that could be causing the pain. There is no quick or sure test that can give a confident 'yes' or 'no' answer.  


Thoracic Outlet Syndrome can present as vascular, neurogenic, or both.


A measurable TOS diagnosis is only possible to obtain with vascular symptoms.


Neurogenic TOS is unable to be tested definitively, and may either be alleviated with alternative therapies, or with a decompression surgery. If these do not work, it was not Neurogenic TOS. 


I experienced both vascular and neurogenic symptoms. 

Alternative treatments to surgery:

  • Massage
  • Anti-inflammatory diet
  • Physical therapy
  • Dedicated yoga practice
  • Extended hiatus from playing
  • Acupuncture
  • Cupping
  • Dry needling
  • Structural integration massage
  • Dedicated meditation and mindfulness practice
  • Psychotherapy
  • EMDR
  • Psychophysiological disorder specialist
  • Body mapping
  • Participation in varied support groups & 12 step recovery



Skype Consultants: 

Jerald Harscher
Dr. Randall Kertz


*Many of the above treatments have become fundamental parts of my healing alongside the choice of surgery, and eventual surgical recovery. Some have further been integrated into my lifestyle.


Thoracic Outlet Syndrome Decompression Surgery

My vascular surgeon opted to remove my first rib on the left side, anterior scalene, and middle scalene muscles.  


Some TOS decompression surgeries include a pec minor release. Mine did not.


The surgery took place on 12/31/2018. 


Physical Therapy took about 6 weeks. During this time I also worked with mental health professionals to maintain optimal well-being and quality of life regardless of surgical outcome and to ultimately promote my best chances of healing. While things weren't exactly "back to normal" as I'd once known, I was ready to go back to work again after about 3 months. 

Surgical Outcome


1 Year Post-Op (2020): I am feeling strong and am at a new and better normal. The incision area is still numb, but is said to improve over time. I have a more connected and healthier relationship to my body and with my guitar. 


There are still instances that I do feel a slight disconnection while playing. I believe that there is ongoing work to do with mind/body connection or psychosomatic disposition when playing the guitar. Luckily, those things do not affect my current ability to work gainfully and I can explore this over time. 


I can't overstate how the items listed above as alternative treatments to surgery have become fundamental parts of my surgical healing. Several of those treatments are now integrated as new tools and aspects of my lifestyle.


I believe that having this experience was an opportunity to intimately inventory my deeper core values and explore how they tie to my identity and musicianship. I learned how to maintain optimal physical and mental health as a professional musician and uncovered new aspirations of how I might contribute to the industry and community as a guitarist and educator. I have gained the ability to approach music and playing guitar in a deeper and informed way that was inaccessible before this struggle.


The symptoms that I once experienced of TOS are now gone.

My lifestyle has changed in many ways from how things were when my symptoms began.


Surgery is an incredibly risky choice, not to be taken lightly or quickly. It is in no way a silver bullet for pain relief. In some ways, surgery can make things worse, more painful, and mentally challenging. This was a decision I could only embark on in good conscience after exhaustive hours of research, giving an honest attempt towards alternate therapeutic options, opening up to and exploring my inner mental landscape, and trusting the vast and varied team of experts that I was building.


That said, I am so grateful to be fully recovered, and I consider my thoracic outlet decompression surgery and multifaceted recovery to be a success. 

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