![]() ![]() Severe headaches are associated with lower brachial plexus nTOS. These patients have paresthesias affecting the ulnar distribution of the hand. The pain radiates down the arm through the ulnar aspect of the forearm into the hand. The typical history of patient with lower brachial plexus nTOS consists of discomfort and pain of varying intensity at the base of the neck. The key is to remember that nTOS occurs in patients with anatomic abnormalities and to look for these on physical examination. Guided by the examination, tests may be offered and therapy planned. After record review, these patients need a comprehensive history and physical examination with the goal of finding out what is wrong with the patient as a whole. This really needs to be done, even though it takes a significant amount of physician time, with no payment for the physician who performs this service. It is important to understand that these complicated patients need to have a comprehensive evaluation, including a thorough review of their records, even if there are so many records that they have to be brought on a flatbed truck. In the case of nTOS, patients are referred for a determination of the presence or absence of nTOS. In this day of increasingly complex testing, the patient is often compartmentalized. Physical Examination in Evaluation of Neurogenic Thoracic Outlet Syndrome (nTOS) ![]() The examining physician needs to understand that TOS is usually neurological and much less commonly vascular.ΔΆ. Since there are no definitive tests for nTOS, the diagnosis is made by performing complete history and physical examinations to develop an understanding of the total clinical picture. Multiple visits to physicians, who either do not believe nTOS exists or who believe that it is a diagnosis of exclusion, aggravate the emotional problems that these patients experience. The stresses caused by chronic symptoms, coupled with the cursory examinations carried out by some physicians, reinforce the conclusion that the problem is psychogenic. They have often been seen by other physicians, many of whom have decided that the symptoms are psychogenic. These patients look normal in spite of pain and dysfunction. Furthermore, a patient may have multiple coexisting conditions, and the challenge is to identify the etiology of various parts of the symptom complex before making recommendations. Symptoms of nTOS are similar to symptoms caused by a wide variety of other conditions. There is no single test which unequivocally allows the diagnosis to be made in a definitive fashion, but certain imaging modalities may be confirmatory. ![]() The diagnosis of nTOS is made by understanding the total clinical picture, and that requires a complete history and physical examination. While they may be right in some circumstances, it is far more likely that nTOS is more commonly underdiagnosed. Some investigators believe that nTOS is overdiagnosed. Neurogenic thoracic outlet syndrome (nTOS) is a relatively common problem which is frequently not recognized. ![]()
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