-
Fascia Tightening ??
Thank you very much for your response, Dr Towfigh, especially given it is a holiday weekend.
Yes, I have been extensively worked up for vascular obstruction and vascular thoracic outlet syndrome.
I have had a positional venography exam looking at the subclavian vein, which proved normal in all positions. I then went to another well-known TOS center, and had a CT angiogram w/ special venous TOS protocol — which also showed no vascular abnormalities. I also had an MRI/MRA done by a radiologist specializing in TOS, and again, there was no evidence of vascular TOS. I have also had another 3 MRIs looking at the brachial plexus region, and another MRI ruling out cervical spine issues.I have also had numerous duplex ultrasound studies (both arterial and venous) and none are showing up abnormal.
The problem is bilateral. I had chronic compartment syndrome in both forearms — and very aggressive fasciotomy/partial fasciectomy surgeries in both forearms. The hand pain and blood pooling began after the forearm surgeries. Veins bulge and visibly dilate in the hand and volar forearm only. Veins are not visible any where else in the extremity, shoulder, chest, or neck.
RSD/CRPS has also been ruled out by numerous specialists and 2 separate triphasic bone scans which were normal.
I recently flew out to Kleinert Kutz, the hand transplant center previously referred to, and they were unable to provide an explanation for my symptoms.
The pain continues to be highly patterned and very severe every single evening. I am unable to sleep, I am unable to spend any time outside in summer heat, and increasingly unable to tolerate warm showers. The muscle compartments are loose and flaccid, particularly the volar compartment, and we know the pressures are very low, 1 mmHg and 3 mmHg – measured at rest midday and the pressures do not increase much after exercise.
Because of the severe pain, I am more than willing to pursue any and all possible causes. But at present, it seems like have ruled out all possibilities and it’s looking more and more like a late sequelae of the fasciectomies.
I would be grateful for any additional thoughts/suggestions ??