Clinical Presentation of Patients with NTOS
The diagnosis of Neurogenic Thoracic Outlet Syndrome (NTOS) is often considered in patients presenting with neck, shoulder, and arm pain, sensory disturbance and weakness especially when these complaints are worsened when assuming certain postures or when
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Clinical Presentation of Patients with NTOS Sheldon E. Jordan
Abstract
The diagnosis of Neurogenic Thoracic Outlet Syndrome (NTOS) is often considered in patients presenting with neck, shoulder, and arm pain, sensory disturbance and weakness especially when these complaints are worsened when assuming certain postures or when performing activities such as reaching overhead. The label of NTOS should be considered when it explains a patient’s suffering and disability; it is important for the clinician to differentiate ubiquitous complaints of innocuous positional numbness from those features of a condition that really are responsible for the patient’s disability. The main goal of the clinician is to determine for whom NTOS targeted therapy would lead to both alleviation of suffering and improve functional impairment. The task of making the diagnosis and finding patients who may benefit from NTOS targeted treatment starts with the discovery of certain positive features which suggest NTOS; the present chapter outlines this initial step in the diagnostic process. Conditions may mimic NTOS or may be comorbid with it having dramatic effects upon treatment outcomes; these conditions are discussed in Chap. 8.
Introduction The diagnosis of Neurogenic Thoracic Outlet Syndrome (NTOS) is often considered in patients presenting with neck, shoulder, and arm pain, sensory disturbance and weakness especially when these complaints are worsened when assuming certain postures or when performing
S.E. Jordan, MD, FAAN Department of Neurology, Neurological Associates of West Los Angeles, 2811 Wilshire Blvd., Suite 790, Santa Monica, CA 90403, USA e-mail: [email protected]
activities such as reaching overhead [1]. The label of NTOS should be considered when it explains a patient’s suffering and disability; it is important for the clinician to differentiate ubiquitous complaints of innocuous positional numbness from those features of a condition that really are responsible for the patient’s disability. The main goal of the clinician is to determine for whom NTOS targeted therapy would lead to both alleviation of suffering and improve functional impairment. The task of making the diagnosis and finding patients who may benefit from NTOS targeted treatment starts with the discovery of certain positive
K.A. Illig et al. (eds.), Thoracic Outlet Syndrome, DOI 10.1007/978-1-4471-4366-6_7, © Springer-Verlag London 2013
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features which suggest NTOS; the present chapter outlines this initial step in the diagnostic process. Conditions may mimic NTOS or may be comorbid with it having dramatic effects upon treatment outcomes; these conditions are discussed in Chap. 8.
Positive Features that Suggest Possible NTOS The diagnostic process starts with a search for features that may suggest NTOS in those patients who present with cervicobrachial pain after an acute injury or after a cumulative work related exposure [2–5]. Classically, the positive findings that suggest NTOS include a history of tingling, deadness, or weakness in the upper extrem
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