title: The enigma of neurogenic thoracic outlet syndrome following motor vehicle collisions.
abstract: BACKGROUND
  The concept of neurogenic thoracic outlet syndrome (N-TOS) including upper and lower plexus syndromes secondary to soft tissue neck injury after motor vehicle collisions (MVCs) has been contentious. We considered that analysis of objective data from this group of patients could provide insight into this controversial type of N-TOS.
  
  
  METHODS
  During the 10-year period January 2001 through December 2010 we examined patients who had received a diagnosis of N-TOS following an MVC. We graded the principal diagnosis based on the objective data from our physical examination.
  
  
  RESULTS
  In total 263 patients received a diagnosis of N-TOS during the study period. At the highest accuracy level of diagnosis there were 56 patients with ulnar entrapment syndrome (UES), 40 with carpal tunnel syndrome (CTS) and 55 with nonorganic disease (NOD), for a total of 151 (57.4%) cases in which the diagnosis of N-TOS was brought into question. The elevated arm stress test (EAST) reproduced the symptoms of UES in 33 of the 56 patients of UES (58.9%) and reproduced the symptoms of CTS in 18 of the 40 patients with CTS (45.0%).
  
  
  CONCLUSIONS
  There appears to be a high incidence of misdiagnosis of N-TOS following MVCs. The EAST is not a prime test for N-TOS.
authors.affiliation: From the Department of Surgery, University of British Columbia, Retired (Munro); and the Department of Orthopedics, University of British Columbia, Retired (McPherson).
authors.forename: A Ian
authors.initials: AI
authors.lastname: Munro
authors.affiliation: From the Department of Surgery, University of British Columbia, Retired (Munro); and the Department of Orthopedics, University of British Columbia, Retired (McPherson).
authors.forename: G Duncan
authors.initials: GD
authors.lastname: McPherson
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D013901:Thoracic Outlet Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology