title: Investigation of nonspecific neurogenic thoracic outlet syndrome.
abstract: OBJECTIVE
  To determine the value of investigations for nonspecific neurogenic thoracic outlet syndrome (NNTOS) and formulate a rational diagnostic approach.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Thoracic surgery clinic.
  
  
  METHODS
  Fifty-six patients referred with a presumptive diagnosis of NNTOS: Patients with arterial, venous, or true (classic) neurogenic TOS were excluded.
  
  
  METHODS
  All patients underwent careful history and examination. Fifty-three had cervical spine radiographs, 45 had electrophysiologic testing, and 30 patients had arterial doppler studies.
  
  
  METHODS
  The value of investigations that documented a diagnosis other than NNTOS could be assessed but objective evaluation of investigations that appeared to support a diagnosis of NNTOS was not possible. No standard diagnostic criteria exist for NNTOS:
  
  
  RESULTS
  Forty (71%) patients were female. Thirty-four (61%) patients had a pulse deficit with provocative maneuvers. Cervical spine radiographs showed cervical ribs in 10 patients and degenerative disease in 11 patients. Electrophysiologic testing demonstrated carpal tunnel syndrome in 11 patients. Arterial Doppler studies were strongly positive for TOS in 10 patients. Thirty-six (64%) patients were diagnosed with conditions other than NNTOS: The diagnosis of NNTOS was accepted in 20 (36%) patients. All 20 patients were initially treated conservatively but 3 (5%) eventually underwent surgery.
  
  
  CONCLUSIONS
  NNTOS is a diagnosis of exclusion. Two thirds of patients referred to a thoracic surgery clinic were eventually diagnosed with conditions other than NNTOS: Objective evaluation of investigations that may support a diagnosis of NNTOS is not currently possible.
authors.affiliation: Department of Surgery, University of Alberta, Edmonton, Canada.
authors.forename: A V
authors.initials: AV
authors.lastname: Sobey
authors.forename: R P
authors.initials: RP
authors.lastname: Grewal
authors.forename: K J
authors.initials: KJ
authors.lastname: Hutchison
authors.forename: J D
authors.initials: JD
authors.lastname: Urschel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013901:Thoracic Outlet Syndrome / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D014463:Ultrasonography