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.
Neurosurgeons treat diseases of the brain and spine.
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.