seeking Physical Therapist (I think?) specializing in RSI for hands+arms
October 9, 2022 3:24 PM Subscribe
SF Bay Area, preferably Upper Peninsula/SM County, or San Francisco. Various tests and multiple Drs tell me I have minor Carpal Tunnel Syndrome, medium+ Cubital Tunnel Syndrome, and likely Thoracic Outlet Syndrome as well. I'd like to connect with someone who can help me learn not only what exercises and movements can help reduce discomfort help build strength, but knows also which movements I need to avoid. In other words, someone with actual experience treating people with complex concurrent conditions affecting the hands, arms, shoulders and upper thoracic region.
I had been seeing a PT for many many months (for a couple different issues) to great satisfaction and progress, but when the diagnosis of possible ToS arrived, she was upfront about not having been trained for or having any experience with it, but we continued on. Turns out a couple of the exercises she recommended made things worse. She had told me I need to see a ‘hand doctor’ for PT, which was odd since I already had two Dr’s on my care team. SO I guess I am looking for some medical or movement professional who understands well what could be happening in an instance where at least one of the arms is experiencing multiple conditions (UNE + ToS, possibly) and can help get me on to a correct care regime.
FWIW, I have a consult soon with a thoracic surgeon at Stanford who’s supposedly the top guy for ToS. My concern is that he has a hammer for a particular kind of nail, and given a recent MRI showing a nail in the form of a ‘fibrous band’ will be keen to operate (which is understandable), but for reasons I don’t have the endurance to type out, I think I have other things going on beyond just the UNE/CuTS and both (a) I'd like to explore those more before going under the knife, and (b) let's say the ToS surgery happens and is successful, there'll still be these other conditions remaining and I will need to attend to those with some type of physical therapy (I presume).
BUT I DIGRESS. I would love any recommendations for really top-notch PT practitioner show have specific experience with RSI issues such as CTS and CuTS/UNE, and knows how to treat Thoracic Outlet Syndrome. SF Bay Area, preferably Upper Peninsula/San Mateo County, or San Francisco.
Thank you!
I had been seeing a PT for many many months (for a couple different issues) to great satisfaction and progress, but when the diagnosis of possible ToS arrived, she was upfront about not having been trained for or having any experience with it, but we continued on. Turns out a couple of the exercises she recommended made things worse. She had told me I need to see a ‘hand doctor’ for PT, which was odd since I already had two Dr’s on my care team. SO I guess I am looking for some medical or movement professional who understands well what could be happening in an instance where at least one of the arms is experiencing multiple conditions (UNE + ToS, possibly) and can help get me on to a correct care regime.
FWIW, I have a consult soon with a thoracic surgeon at Stanford who’s supposedly the top guy for ToS. My concern is that he has a hammer for a particular kind of nail, and given a recent MRI showing a nail in the form of a ‘fibrous band’ will be keen to operate (which is understandable), but for reasons I don’t have the endurance to type out, I think I have other things going on beyond just the UNE/CuTS and both (a) I'd like to explore those more before going under the knife, and (b) let's say the ToS surgery happens and is successful, there'll still be these other conditions remaining and I will need to attend to those with some type of physical therapy (I presume).
BUT I DIGRESS. I would love any recommendations for really top-notch PT practitioner show have specific experience with RSI issues such as CTS and CuTS/UNE, and knows how to treat Thoracic Outlet Syndrome. SF Bay Area, preferably Upper Peninsula/San Mateo County, or San Francisco.
Thank you!
Best answer: I am a physical therapist in outpatient orthopedics, but I'm not your PT. This is not medical advice, just a constellation of thoughts surrounding what you've described. Iff your diagnoses are correct then a knowledgeable physical therapist should have no difficulty treating you. If you require another diagnosis, a PT is capable of that as well.
The only time you should rush to surgery for thoracic outlet syndrome (TOS) is in cases of vascular TOS. Those cases are emergency situations in which your arm turns black/blue due to severely compromised blood flow. It is extremely rare and not something people just walk around with. The type of TOS people typically have is disputed neurogenic TOS. It is very treatable, as is cubital and carpal tunnel syndromes that often co-occur due to general inflammation of the nervous tissue; once a nerve is irritated at one location, it more easily becomes irritated at others along its distribution.
If you have TOS then your treatment should include the basics such as 1st rib mobilizations, Cyriax Release, cervical mobilizations, postural education and strengthening, and ergonomics of your workplace. You should be educated in the rational for all of these interventions such that they make sense to you, as well as how to perform them at home. You should be educated so that you understand your condition and what you can do about it.
Finding a therapist that is effective can unfortunately be a challenge. I've had success with patients that failed PT multiple times previously (or PT failed them). There's no sure fire screening tool, but I'll offer suggestions on what to look for. I would look for a clinician with their Certificate of Orthopedic Manual Therapy (COMT) and/or who is a Orthopedic Clinical Specialist (OCS), or who is a Fellow in the American Academy of Orthopedic Manual Physical Therapists (FAAOMPT). With that being said there are plenty of fine PTs without the alphabet soup behind their names; I am in the process of getting a COMT through the International Academy of Orthopedic Medicine (IAOM) and don't have other certifications. Looking at the clinic culture is another clue to the quality of care; are there therapists pursuing these certifications or with them. It offers a clue as to the clinic's priorities.
I did a quick Google search for "IAOM physical therapy San Francisco" -- because I really like the IAOM's methodology and courses -- and came across Agile Physical Therapy. They have multiple locations and many therapists with their FAAOMPT or COMT (the certificates I'd value most). By the way being a Doctor of Physical Therapy (DPT) is just the entry level qualification for new grads, it's nothing special and has no meaning above Physical Therapist (PT) for patients. One other note is to ask about treatment session lengths and one on one care. You want a place that offers 45-60 minute treatments that is one on one with a physical therapist. That is, the therapist has one patient at a time and you are not being shuffled between a PT and a PTA or aide in one session, or ideally ever, though there are good PTAs out there.
Feel free to message me if you have more questions.
posted by galennaklar at 9:07 PM on October 9, 2022 [6 favorites]
The only time you should rush to surgery for thoracic outlet syndrome (TOS) is in cases of vascular TOS. Those cases are emergency situations in which your arm turns black/blue due to severely compromised blood flow. It is extremely rare and not something people just walk around with. The type of TOS people typically have is disputed neurogenic TOS. It is very treatable, as is cubital and carpal tunnel syndromes that often co-occur due to general inflammation of the nervous tissue; once a nerve is irritated at one location, it more easily becomes irritated at others along its distribution.
If you have TOS then your treatment should include the basics such as 1st rib mobilizations, Cyriax Release, cervical mobilizations, postural education and strengthening, and ergonomics of your workplace. You should be educated in the rational for all of these interventions such that they make sense to you, as well as how to perform them at home. You should be educated so that you understand your condition and what you can do about it.
Finding a therapist that is effective can unfortunately be a challenge. I've had success with patients that failed PT multiple times previously (or PT failed them). There's no sure fire screening tool, but I'll offer suggestions on what to look for. I would look for a clinician with their Certificate of Orthopedic Manual Therapy (COMT) and/or who is a Orthopedic Clinical Specialist (OCS), or who is a Fellow in the American Academy of Orthopedic Manual Physical Therapists (FAAOMPT). With that being said there are plenty of fine PTs without the alphabet soup behind their names; I am in the process of getting a COMT through the International Academy of Orthopedic Medicine (IAOM) and don't have other certifications. Looking at the clinic culture is another clue to the quality of care; are there therapists pursuing these certifications or with them. It offers a clue as to the clinic's priorities.
I did a quick Google search for "IAOM physical therapy San Francisco" -- because I really like the IAOM's methodology and courses -- and came across Agile Physical Therapy. They have multiple locations and many therapists with their FAAOMPT or COMT (the certificates I'd value most). By the way being a Doctor of Physical Therapy (DPT) is just the entry level qualification for new grads, it's nothing special and has no meaning above Physical Therapist (PT) for patients. One other note is to ask about treatment session lengths and one on one care. You want a place that offers 45-60 minute treatments that is one on one with a physical therapist. That is, the therapist has one patient at a time and you are not being shuffled between a PT and a PTA or aide in one session, or ideally ever, though there are good PTAs out there.
Feel free to message me if you have more questions.
posted by galennaklar at 9:07 PM on October 9, 2022 [6 favorites]
Edit: you mentioned a fibrous band and I didn't address that in my OG post. Fibrous tissue is able to be modified with PT and you should definitely give it a go with a knowledgeable therapist before having surgery.
posted by galennaklar at 9:14 PM on October 9, 2022
posted by galennaklar at 9:14 PM on October 9, 2022
Best answer: I had similar issues and had a fantastic experience at the Stanford Hand Clinic in Redwood City. The regular PTs I'd been going to before also gave me exercises that worsened things, but the folks at the hand clinic had deep specialized knowledge that really helped me out (ie, ergonomic tips + regimens tailored for me that weren't just easily found online).
I was also referred to a Stanford surgeon specializing in TOS, but thankfully did not need surgery. Feel free to message me for any more info re: my experiences with specific providers or more details.
posted by bongerino at 4:37 AM on October 10, 2022
I was also referred to a Stanford surgeon specializing in TOS, but thankfully did not need surgery. Feel free to message me for any more info re: my experiences with specific providers or more details.
posted by bongerino at 4:37 AM on October 10, 2022
I would absolutely consider an occupational therapist with a specialization in hand therapy as well. Many have extensive training in the hand and upper extremity.
posted by Amy93 at 5:25 PM on October 10, 2022
posted by Amy93 at 5:25 PM on October 10, 2022
This thread is closed to new comments.
One way to go about finding a particularly effective therapist is to figure out whoever the musicians of the SF Symphony see, as string players often have RSI issues similar to the ones you mention. Unfortunately I don’t know who that is, I’ve just been in treatment for some of the issues you mention both from “musical injuries” and others and know that there’s a fair amount of overlap.
Good luck! Unfortunately in my experience the treatment can be a little bit trial-by-error. Feel free to MeMail if I can help at all, but unfortunately it’s been long enough that I would be surprised if any of the providers I saw are still practicing where I saw them.
posted by A Blue Moon at 8:57 PM on October 9, 2022