You are reading Chapter III – The Thoracic Outlet Syndrome Controversy
THORACIC OUTLET SYNDROME
by Dr James Stoxen DC
The Thoracic Outlet Syndrome Controversy
Table of Contents
Chapter I What is Thoracic Outlet Syndrome? (TOS)
Chapter II Anatomy
Chapter III The TOS Controversy
Chapter IV History, Cause, and Patient Presentations
Chapter V Physical Examination Findings
Chapter VI Diagnostic Tests
Chapter VII Standard of Care Approaches – Surgical and Non-Surgical
Chapter VIII Frequently Asked Questions
Chapter IX Case Histories of Patients
Chapter X The Human Spring Approach to Treatment and Prevention
Thoracic Outlet Syndrome controversy
Thoracic Outlet Syndrome is controversial in the medical community.
Here is why…
Under diagnosed or over diagnosed
Some physicians say that this syndrome is under-diagnosed. I read a letter to the editor in a surgical publication, which said that this physician said it was under-diagnosed and that more thoracic outlet syndrome actually existed, while other physicians say it was over-diagnosed. We say that it is under-diagnosed.
No Gold Standard Test Exists
The problem with this syndrome and the difficulty with this syndrome is that many physicians say there is no gold standard tests for thoracic outlet syndrome. In order to diagnose thoracic outlet syndrome you have to put together an array of historical findings, physical findings and a couple of provocative orthopedic tests in the region of the neck and shoulder to be able to make that diagnosis.
The Most common Treatment is Surgery
The most common treatment today for thoracic outlet syndrome is surgery. According to the literature, if you have a group of 500 patients only 10% will respond to conservative therapy, which leads to 90% goiing to surgery. Doctors often times give up on initiating conservative therapy and go directly to surgery. We have to put ourselves in the position of the patient. As you can see on the graphic above we have a thoracic outlet surgery of the neck. There are many tiny important structures in this area. Patients are in great fear of surgery, especially in the neck so the answer is no patient wants to have this surgery.
Surgery is unnecessary with the right approach
We have a very high rate of recovery from thoracic outlet syndrome with conservative care, and I am very happy to present that form of treatment to you today. I have not referred a patient for surgery for a thoracic outlet syndrome in 18 years of practice. That includes thousands of patients over these 18 years. I was very shocked when I looked into the literature. I am aware of the rhizectomy, removal of the first rib. I was curious about other therapies so I reviewed over 325 scientific papers that discussed conservative methods of therapy, including stretching and what the procedures and protocols were used to treat these patients conservatively.
Why Current Conservative Therapy is Unsuccessful
I think that after reading this, you will find out why these treatments were unsuccessful. You are going to have a better understanding of the most common cause of this syndrome. I feel that with a better understanding of what causes this syndrome, you will have better results with conservative therapy of this syndrome.
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