How do we diagnose thoracic outlet syndrome?

Thoracic outlet syndrome (TOS) is a complicated condition to diagnose. There are those who do not believe that the neurogenic type even exists.

Many of our patients report consultations where they have been told they have a psychological problem. Some have undergone unsuccessful operations or treatment for other possible conditions.

Therefore:

Firstly, the clinician must believe that TOS is a possibility.

Secondly, be skilled and experienced in diagnosing all forms of spinal and upper limb pathologies in order to exclude alternative conditions.

Thirdly, must be trained in the specific diagnosis of TOS.

Here at The Cherington Practice, Rob Patterson is our thoracic outlet syndrome diagnostician.

Having carefully taken a history, listened to the description of symptoms and performed a gentle meticulous examination with relevant special tests, Rob will decide whether investigations will be needed and what type. These could include x-rays, MRI, nerve conduction studies, muscle anaesthetic blocks or Duplex ultrasound scans. If it is thought that arterial or venous TOS is present you will be referred to a vascular surgeon for further evaluation.

When we confirm the diagnosis of neurogenic TOS (NTOS) we then decide if conservative treatment is appropriate. If the condition is too advanced you will need surgery so we will refer you to an appropriate surgeon.