Assessment and documentation of the level of disability is often required if relief from work is necessary in initial management, and in guiding later decisions about treatment. Such patients may have been prevented from working for long periods of time before consultation, or may have attempted to persist in work-related activities despite ongoing neurogenic symptoms. These patients often describe progressive disability, a long history of specialist physician consultations, and multiple partial or ineffective treatments. There is little risk of progressive injury in these situations, and most patients will improve with conservative management, not requiring more specific intervention.Ī smaller subset of patients with neurogenic TOS exhibit progressively disabling symptoms, which effectively prevent them from working or carrying out simple daily activities. These symptoms are usually due to transient irritation of the brachial plexus in certain positions or activities of the arm. Most individuals with neurogenic TOS have only positional upper extremity complaints and are affected to a mild and tolerable degree. It is particularly helpful to obtain from the patient a detailed description of activities that exacerbate symptoms, as well as those activities normally required in the workplace. (For stories of patients treated for neurogenic TOS by Robert Thompson, MD, at The Washington University Center for Thoracic Outlet Syndrome at Barnes-Jewish Hospital, see “Patient Features” in top menu bar.)Īn important part of the initial assessment is concerned with evaluating the extent of the patient’s disability and expectations for continuing or returning to work. Patients with neurogenic TOS often exhibit normal or nonspecific findings on conventional electrophysiological testing and/or imaging studies, and are thereby identified on the basis of positive clinical findings and the exclusion of other conditions through a process known as differential diagnosis. Neurogenic TOS is characterized by compression of the brachial plexus nerve roots (C5 to T1) within the scalene triangle and/or subpectoralis space (see anatomy of TOS). May also develop in patients with no apparent predisposition because of congenital anatomical variations or a history of trauma.Frequently develops following various types of injury to the head, neck or upper extremity (e.g., a motor vehicle collision or a fall upon the outstretched arm).Often occurs in individuals engaged in occupational or recreational activities that involve repetitive overhead use of the arms and/or heavy lifting.Can occur in adolescents as well as in middle age.Most frequent in individuals between 20 and 40 years of age.From 85-95% of all patients with TOS are affected by neurogenic TOS.Important characteristics of neurogenic TOS include: This section also includes some basic information on our approach to caring for patients with TOS, what you can expect in the course of evaluation and treatment, and details that may be useful in planning a visit to our Center. We have also provided information here that may help in navigating work-related and legal issues surrounding TOS. We have tried to provide information that we hope will be helpful to our patients in order to better understand the diagnosis, nonsurgical management, and surgical treatment of all types of TOS, including: The primary purpose of the Washington University Center for Thoracic Outlet Syndrome at Barnes-Jewish Hospital is to better treat patients. Notice of Privacy Practice for Patients (HIPAA).What Your Can Expect from Your Visit – Staying in St.What You Can Expect From Your Visit – Overview.Neurogenic Thoracic Outlet Syndrome (TOS).Arterial Thoracic Outlet Syndrome (TOS).
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