ABSTRACT
Neurogenic thoracic outlet syndrome (N-TOS) is a chronic illness that may involve part or all of the brachial plexus. It is predominantly a sensory disorder of pain and paresthesias, although it often includes motor dysfunction. It represents an entrapment neuropathy of a highly irritable brachial plexus. Maneuvers to test its ability to glide and its irritability will reproduce symptoms. The diagnosis of N-TOS is based on a detailed clinical evaluation. Laboratory findings and test results only apply in the context of the clinical findings. One needs to commit time to determine the nature of the problem. The trapezius, levator scapula, and rhomboid muscles support the scapula on the posterior chest wall. When overused, as in cumulative trauma or as injured in a whiplash, these muscles develop tonic spasm that increases shoulder traction of the brachial plexus. The pain usually radiates from the neck through the shoulder and through the supraclavicular area, and then down the upper extremity.
