Finding a thoracic outlet syndrome specialist may be the most important step you can take
Find a Thoracic Outlet Syndrome (TOS) Specialist. TOS patients recover more quickly when a provider completes the diagnosis of thoracic outlet syndrome accurately and quickly, and when appropriate treatment of thoracic outlet syndrome starts promptly. Why do some specialists excel at diagnosing and treating TOS patients, and how do you find the best thoracic outlet syndrome specialist?
As a patient, you should find a thoracic outlet syndrome specialist who can provide you with the information you need to understand TOS and to make the best treatment decisions. An experienced thoracic outlet syndrome specialist can help you make the best decisions between treatment options, including physical therapy, thoracic outlet syndrome exercises, and various types of thoracic outlet syndrome surgery.
Many TOS patients face the challenge of finding a qualified thoracic outlet syndrome specialist. We understand the obstacles, and we aim to provide information to help patients with that challenge.
Early diagnosis of thoracic outlet syndrome is critical for successful treatment of thoracic outlet syndrome
Early and accurate diagnosis of thoracic outlet syndrome enables prompt and precise treatment of thoracic outlet syndrome. However, your physician may be unfamiliar with TOS, inexperienced with TOS, or unable to diagnose TOS quickly and accurately. In this case, you may not receive prompt treatment. For this reason, it is important to understand how to recognize or find a qualified thoracic outlet syndrome specialist.
Unfortunately, we have seen many patients with chronic pain from undiagnosed and untreated TOS. As a result, we have heard many stories of multiple visits to multiple doctors, without a satisfying answer or diagnosis. By the time the patient finds a doctor familiar with TOS, the challenges feel overwhelming.
It is important to realize that earlier diagnosis means less pain, faster recovery, and better outcome for many TOS patients.
Thoracic outlet syndrome falls outside any single medical specialty
Highly-trained specialists and sub-specialists form the foundation of modern health care in America. Patients are very comfortable knowing they can always find a highly-qualified provider for just about any medical condition that develops.
For example, when you break a bone, you see an orthopedic surgeon.
When you are pregnant, you see an obstetrician.
When you have chest pain, you see a cardiologist.
An orthopedic surgeon knows bones. An obstetrician knows the mom and the baby. A cardiologist knows the heart. But who knows the thoracic outlet?
The thoracic outlet is not the neck, not the chest, nor the shoulder. The thoracic outlet is not the nerves, not the arteries, nor the veins. Because of the complexity of the thoracic outlet, it has never lived within the territory of a single medical specialty.
You cannot search the phone book or Google for your local university hospital TOS medical group. That’s the bad news. At the same time, there is good news. While TOS does not fall within one specialty, there are practitioners of many different specialties that do know TOS quite well. We are here to help you find them.
What specialists see thoracic outlet syndrome patients?
Ordinarily, when you search for a medical specialist, you search based on the type of training that person has completed. However, you cannot search for specialty training that guarantees knowledge or experience in diagnosing and treating TOS patients. In other words, there is no medical specialty whose curriculum uniformly trains graduates in the diagnosis and treatment of thoracic outlet syndrome.
Conversely, many providers trained in many different specialties have earned the knowledge and experience to treat TOS patients. To put it another way, searching by specialist is likely to be of little help. But searching based on TOS knowledge and experience can be fruitful. And while no medical specialty ‘owns’ TOS, there are many specialties within whose ranks you can find a TOS specialist.
We can start by understanding what each thoracic outlet syndrome specialist does. In this way, we can understand how each specialist can help TOS patients.
A neurosurgeon is a physician who diagnoses and treats diseases, disorders, and injuries of the nervous system and its supporting structures. Specifically, the human nervous system includes the central nervous system and the peripheral nervous system. In detail, the central nervous system comprises the brain, cranial nerves, and spinal cord. In general, the skull and spine contain and enclose the central nervous system. Once the nerves exit the spine, they compose part of the peripheral nervous system. Overall, the peripheral nervous system comprises nerves, ganglia and plexuses. For example, the brachial plexus is part of the peripheral nervous system. The supporting structures include the skull and spine, and the soft tissues of the spine. These soft tissues comprise spinal disks, ligaments, blood vessels, and membranes that cover the brain and spinal cord.
A neurosurgeon may specialize in one region, such as the spine. Alternately, a neurosurgeon may focus on a specific field or condition, such as tumors, trauma, stroke, or peripheral nerve diseases.
Some patients with compression of a nerve (known as entrapment neuropathy) undergo treatment by a neurosurgeon. Thus, some neurosurgeons have historically treated TOS patients.
An orthopedic surgeon is a physician who diagnoses and treats diseases of the musculoskeletal system. In detail, the musculoskeletal system comprises the bones, joints, and their associated soft tissues, namely muscles, tendons and ligaments.
An orthopedic surgeon may specialize in one area of the body, such as the shoulder or the spine. In contrast, an orthopedic surgeon may concentrate their practice in one field, such as sports medicine, trauma, or bone tumors.
Some TOS patients have a cervical rib, or compression of the brachial plexus between the clavicle and normal first rib. Since orthopedic surgeons treat bone disorders, some orthopedic surgeons have historically treated TOS patients.
A plastic surgeon is a physician who specializes in reconstruction, restoration, or alteration of the body. Obviously, many people are familiar with aesthetic or cosmetic surgery. In this field, a plastic surgeon corrects or improves the appearance of the face or body. However, many people may not know about the plastic surgeons who perform reconstructive surgery. Specifically, these physicians reconstruct or improve the function of a body part. For example, there are plastic surgeons who specialize in hand surgery, burns, craniofacial surgery, microsurgery, and peripheral nerve surgery.
In fact, plastic surgeons who perform peripheral nerve surgery diagnose and treat TOS patients.
Vascular surgeons study and treat diseases of blood vessels, such as aneurysms and traumatic injuries. Historically, vascular surgeons have been a primary source of treatment for TOS patients. This is likely due to early cases of venous thoracic outlet syndrome or arterial TOS. Vascular surgeons train to understand the anatomy of the thoracic outlet due to these types of TOS.
Radiologists are experts in all imaging techniques. A thoracic outlet syndrome radiologist can create the best imaging protocols for TOS patients and provide valuable anatomic information for the other team members.
A chiropractor is a highly-trained health care professional specializing in the diagnosis and treatment of neuromuscular disorders. Specifically, chiropractors treat their patients through manipulation and adjustment of the spine. In effect, chiropractors restore normal spinal anatomy and promote normal spinal biomechanics. As a result of this treatment, their patients maintain better posture, balance and motion. Consequently, patients avoid compression of the nerves that pass through the spine on their way throughout the body.
On balance, chiropractors treat many patients with pain, and they have extensive experience treating nerve disorders. For this reason, chiropractors often diagnose and treat TOS patients.
A physiatrist treats patients disabled by disease, disorder, or injury. This specialist physician practices physical medicine and rehabilitation. A physiatrist practices non-surgical diagnosis and treatment, and may lead a comprehensive team. The team may comprise physical therapists, occupational therapists, recreational therapists, rehabilitation nurses, psychologists, and social workers, among others.
A physiatrist often uses a nerve diagnostic tool known as electromyography (EMG) and nerve conduction studies [NCS]. He or she may perform non-invasive non-surgical procedures, such as injections into a joint or bursa.
A physiatrist may specialize in one type of disorder or injury, such as stroke or sports injuries. Since many TOS patients become disabled if not successfully treated, physiatrists may be familiar with TOS.
A neurologist is a physician who diagnoses and treats diseases, disorders and injuries of the human nervous system. In this case, the nervous system includes the brain and spinal cord, peripheral nerves, muscles, and supporting structures. Neurologists often practice excellent diagnostic skills based on their clinical neurologic examination. Additionally, some neurologists use diagnostic tools including EMG/NCV (muscle and nerve conduction tests) or EEG (brain activity tests). Neurologists may specialize in one field, such as stroke, multiple sclerosis, sleep disorders, dementia, headache, or tumors.
Because TOS frequently involves the brachial plexus, a nerve network, neurologists see TOS patients with significant frequency.
A pain management specialist is a physician who diagnoses and treats patients who suffer from many types of pain. In general, they diagnose and treat patients with acute pain or chronic pain. In particular, their patients suffer pain from many different causes, including injury, surgery, diabetes, cancer, or nerve damage. Obviously, pain management specialists have tremendous experience in the use of pain medications. However, they also perform non-invasive procedures such as guided injections. Frequently, pain management specialists manage and lead a team of providers, especially in the treatment of patients with chronic pain.
Given that most TOS patients have pain as a primary symptom, pain management specialists frequently take care of these patients.
An internist is a physician who specializes in the comprehensive diagnosis, treatment, and prevention of disease in adults. An internist is knowledgeable across all organ systems and diseases seen in adults. Since internists maintain a broad field of knowledge, they often demonstrate great skills of diagnosis, especially for multi-system diseases. Additionally, internists often manage the overall care plan for their patients for much of their lives.
After their training in internal medicine, many internists train in more specialized specialties, including cardiology, gastroenterology, and hospitalist training.
Generally speaking, internists manage all of their patients’ care for long periods of time. Thus, they are often the first physician to recognize the signs and symptoms of TOS.
A physical therapist is a health care professional who assesses and treats patients with limitations of normal movement or function. Physical therapists may specialize in sports medicine, cardiopulmonary disease, stroke, or neurologic rehabilitation, among other specialties.
Physical therapists use similar diagnostic tools as used by physicians and other health care professionals. In general, these include x-rays, CT scans, and MRI scans. Additionally, physical therapists may use EMG/NCV (nerve tests) in certain cases.
Physical therapists use many treatment modalities. Specifically, these include manual therapy and manipulation, physical agents such as cold or heat, and traction or other mechanical devices. Physical therapists use education to develop, restore, and maintain maximal functional movement through an individual’s lifetime.
Because physical therapists understand patient motion and function on an intimate level, they often diagnose TOS extremely early.
An occupational therapist is a licensed health professional who enables patients to perform their daily occupations. To clarify, occupations in this sense means activities of daily living as well as work occupation. Specifically, occupational therapists assist patients with physical disorders, cognitive or emotional disorders overcome these challenges to regain their normal occupations. In general, occupational therapists work with patients of all ages, with many underlying challenges, including elderly or disabled people. However, it is their work with chronic pain patients that puts them in contact with TOS patients.
An acupuncturist practices acupuncture, a form of Traditional Chinese Medicine (TCM). In the US, most authorities classify acupuncture as an alternative form of medicine. Most people are aware of this practice, where an acupuncturist inserts long, thin needles into the skin. However, acupuncturists practice different styles of acupuncture, and have developed ancillary techniques in conjunction with the acupuncture needles. Acupuncture practitioners have developed several theories to explain the mechanism of acupuncture. Western medicine research studies demonstrate variable results, and the anatomic basis of meridians and qi remain unconfirmed.
Many patients find relief from regular acupuncture treatments. While acupuncture should not replace other forms of diagnosis and treatment, patients often find alternative treatments help their progress.
A massage therapist uses touch and pressure to help relieve pain, reduce stress, and increase relaxation. In general, a massage therapist may treat patients of any age and occupation, for a number of health issues. Massage therapists may use their hands, elbows, forearms or fingers. Often they include heat, dedicated massage tables or chairs, and oils or lotions as ancillary components. Massage therapists may specialize in a large number of massage styles. Specifically, patients may know of deep tissue massage, Swedish massage, sports massage or prenatal massage.
Given the hands-on nature of massage therapy, it is no surprise that chronic pain patients get value from massage therapy. Massage is an adjunct to, but not a replacement for, other forms of treatment for TOS.
After you find your TOS specialist, how do you manage all of the information they give you? In fact, many TOS patients are overwhelmed after receiving the diagnosis of neurogenic thoracic outlet syndrome. Most NTOS patients are not doctors, and even many doctors are confused by the TOS terminology they haven’t previously heard.
As a patient, you may face challenges understanding the results of your tests and your treatment options. While your TOS specialist may be at the top of their field, many neurogenic thoracic outlet syndrome patients get a second opinion. In addition, multi-specialty teams of providers often provide the best TOS outcomes. So how are you as a patient to absorb all of the information and make the best decision, especially if some of your TOS specialists offer differing opinions?
The most important member of your team is the physician who can review, understand, and integrate all of your test results. This person can help you understand your treatment options, especially if your TOS specialists offer differing choices. That burden should not fall on you, the patient.
For many TOS patients, your primary care physician serves best as the ‘quarterback’ of your TOS team. Your primary care physician knows your medical history best, and in many cases may be the first to recognize the early signs and symptoms of neurogenic thoracic outlet syndrome. Learn more about primary care physicians and TOS here.
In some situations, it might make more sense for one of your TOS specialists to assume the role of quarterback. That specialist might be the first physician to have diagnosed you, or the surgeon in a situation where surgery is the next best step forward. Or perhaps it is the TOS specialist of any speciality whom you connect best with, whom you trust through your relationship over the course of diagnosis and treatment.
Keep in mind that you as the TOS patient need to clarify with your chosen primary care physician or TOS specialist that you intend to relay on their skill set and guidance to make this relationship work to your benefit. You will trust them to guide your decisions, and they will use their training and experience to separate the wheat from the chaff, to empower your decisions.
How do you find the best thoracic outlet syndrome specialist for you?
By now, you likely know that no medical specialty uniformly trains doctors to diagnose and treat TOS patients. As a result, you cannot search for a TOS specialist just by specialty. And no doctor treats TOS patients only. However, thoracic outlet syndrome specialists are available in many parts of the country, and we can help you find one.
With this in mind, how do you find your thoracic outlet syndrome specialist?
Start right here with our interactive map of thoracic outlet syndrome specialists. Find a TOS specialist near you, find a TOS specialist with specific training, or find a TOS specialist you have read about online. Visit toseducation.org for more resources on thoracic outlet syndrome.
Interactive map of thoracic outlet syndrome specialists
What questions should you ask a thoracic outlet syndrome specialist?
After you find a thoracic outlet syndrome specialist, how do you learn more about their expertise and experience?
We suggest the following questions as a starting point for opening a discussion with your potential thoracic outlet syndrome specialist:
How long have you been seeing patients with thoracic outlet syndrome?