David Nelson Hand Surgery Greenbrae Marin hand specialist surgery of the hand orthopedics San Francisco



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Thoracic Outlet Syndrome

Thoracic Outlet Syndrome (TOS) is a the name given to a variety of clinical conditions in which the nerves and/or the arteries (collectively called the "neurovascular bundle") of the arm are constricted in the region of the base of the neck and the upper shoulder. The constriction of, or pressure on, the neurovascular bundle can be from bony, ligamentous, or muscular structures, or a combination of structures. These structures are usually congenital (present from birth) but slowly become symptomatic (cause symptoms) as the patient gets older. The nature, treatment, and even the existence of the syndrome is an area of debate and research. Luckily, most patients can be treated (ie, not "cured" but improved to the point that they do not need surgery) by appropriate patient education, activity modification, and therapy.

I would recommend a paper by a highly respected physical therapist, Peter Edgelow, who I know personally and whose approach has been shown to be very effective in my practice. You can read what he and co-authors have written here (. Another page on TOS is by The Nicholas Institute of Sports Medicine and Athletic Trauma. (Please note: I usually only link to websites when I personally know the authors. I do not know anyone at the NISMAT, but feel that their information was of good quality when I first reviewed their content. I do not necessarily agree with all of the content, but do feel that it is a quality, responsible site.)

Would you like to search the medical library of the National Library of Medicine for scientific papers on this topic? Just click on the Pub - Med image:
Remember the admonition from the Patient Education Links Page: the Internet has a lot of information, much of it incorrect. I have reviewed the sites that I have linked to, and have only linked to sites when I personally know the surgeon who posted it, or am a member of the organization that posted it. However, I may not agree with all that is on that site, and it may have changed since I reviewed it. If any of the information is not consistent with what I have told you, please download the material and bring it in.