Pathways of care and treatment options for patients with NTOS

Thoracic outlet syndrome (TOS) is a rare and complex group of disorders that may cause severe and disabling symptoms, and caring for patients with these conditions provides many challenges to health care providers. An organized, systematic, approach to the diagnosis and treatment of TOS provides an opportunity for specialists to deliver patient-centered care and to achieve optimal results with treatment. This specialized type of care is best delivered through the efforts of a multi-disciplinary team that consists of various specialists, including vascular surgery, thoracic surgery, neurology/neurosurgery, orthopedics, radiology, anesthesiology, pain management, physical therapy, and occupational therapy. This chapter will focus on the care path for managing patients with a diagnosis of neurogenic TOS (NTOS), as based on our experience at Washington University/Barnes-Jewish Hospital in St. Louis. Evaluation and care of patients with venous and arterial forms of TOS are covered elsewhere in this textbook.