Brief Answer:
QUESTION: Could this be MS?

Detailed Answer:
Good morning sir and thank you very much for your question on this network. Though not directly stated in the description of the problem I believe you would like to know if the symptoms you are having constitute the diagnosis of MULTIPLE SCLEROSIS ("ms?").

The definition of MS is essentially a disease process, autoimmune in nature, with symptoms whose origin are from the central nervous system (brain or spinal cord) that are disseminated in both space and time. It seems that things got started back in XXXXXXX 2012 when thoracic outlet was first diagnosed in a shoulder (not specified which side). Also, you mention "brachial plexus" but it would be helpful if you could specify the actual symptoms since there is something called a brachial PLEXOPATHY and another called a brachial PLEXITIS. The latter usually involves a lot of pain in a fairly large distribution of the upper extremity together with muscle weakness and wasting in more severe cases while the former usually doesn't involve the same type of pain symptoms but is mostly numbness/tingling and weakness of certain muscles.

In the PLEXOPATHY the precipitating factor is almost always a traumatic injury to the shoulder/neck region and would be classified as a PERIPHERAL NERVE process therefore, MS would not really be a consideration if this were truly the case. The diagnosis of a plexopathy is easy to make when combining the results of a good neurological examination and electrical study called an EMG/NCV.

In the PLEXITIS there is a strange presentation where most patients awaken from sleep in the morning with a severe pain in the shoulder region followed by shoulder, arm, and forearm muscles going weak and demonstrating varying degrees of wasting. The cause is unknown by thought to be precipitated by some type of injury to the brachial plexus such as a virus or following a vaccination or hospitalization which somehow attacked a portion of the brachial plexus. The majority of cases seem to be localized to what is known anatomically as the UPPER TRUNK region of the brachial plexus.

It would appear that you've also had a right labral surgery for a tear of some type and now have been diagnosed with RSD which is the antiquated term for what we now refer to as COMPLEX REGIONAL PAIN SYNDROME. Again, you did not specify the symptoms, however, in this disorder the origin of the problem is usually a TRAUMA of some sort to a portion of the body such as a long bone area or large joint such as a crush injury, fracture, deep burn, or severe contusion which heals but then, leaves patients with residual symptoms of hypersensitivity which can be excruciating. There may be changes in autonomic function in the local area of interest such that skin discolorations during attacks and temperature controls can be lost resulting in purplish coloration and coldness that can be felt. Tactile sensation is altered and even the slightest stimulation over the area in question can trigger explosive pain. Again, this type of presentation is usually not mistaken for MS since it is completely PERIPHERAL in nature and outside the territory of influence of the brain and spinal cord.

You also mention persistent pain traveling into the legs and this is usually the result of some type of lower back or lumbar spine problem such as degenerative disk disease (not uncommon in people who are 40+ who have histories of injuries/orthopedic surgeries, etc.). Again, something like that is also fairly easily looked into by getting appropriate imaging studies and/or electrical studies to complement so that either a peripheral nerve lesion can be found, or if the symptoms can be tracked back to something such as a chemical/metabolic deficiency such as thyroid, parathyroid, Vit. B12, Vit. D, folate, or testosterone deficiency of which you've mentioned at least the latter as a problem then, the symptoms can be explained in that way.

Therefore, on the basis of your presentation and the lack of other important diagnostic testing information (such as MRI of the brain and spinal cord) I would not be initially thinking in terms of MS at the outset and I think your symptoms are explained by other phenomenon as you've stated.

However, if there is a suspicion on your part that MS should be looked into because there are other symptoms that you've not described or things happening not otherwise accounted for by the diagnoses given over the years then, you should engage your neurologist (or find a neurologist with whom you can have an examination) into that as a possibility and see if they would be available to order an MRI of the brain and appropriate parts of the spinal cord such as the cervical and lumbar spines which, if MS would disclose the classic demyelinating lesions that the radiologist can call. That would be the best way of investigating that diagnosis if other things don't seem to be explaining the symptoms satisfactorily.

If I have satisfactorily addressed your questions or concerns would you do the kind favor of CLOSING THIS QUERY and be sure to include some fine words of feedback on your opinion as to our transaction?

Many thanks for posing your question to our attention on this network and do not forget to recontact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 42 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

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