Neurogenic TOS in the United Kingdom: A Consultant Orthopaedic Physiotherapist’s View

In 2015 a survey of UK TOS surgeons suggested that there was confusion and controversy with respect to Neurogenic Thoracic Outlet Syndrome (NTOS), with no agreed diagnostic or management strategies. Furthermore it was identified that patients with NTOS had been on a merry-go-round of multiple opinions, investigations and unhelpful procedures. It appeared that these patients with NTOS fell into a diagnostic void, particularly between spinal and upper limb clinics. In this chapter we describe the origins of the UK’s first Thoracic Outlet Syndrome Centre of Excellence (TOSCOE®) and its mission to address these problems through raising awareness of TOS throughout the UK, improving access to treatment and care for patients and to support the training of surgeons and physiotherapists. Through lectures and masterclasses, a method of diagnosis is being taught based on the four criteria described in the Society for Vascular Surgery’s Thoracic Outlet Reporting Standards Document. A solid campaign is well underway, aiming to reduce this merry-go-round of costly conflicting clinical appointments and treatments. There are huge savings to be made by the National Health Service (NHS) and private medical insurers, through early accurate diagnosis and treatment of this condition. Encouragingly the UK NTOS landscape is beginning to change; new TOS clinics are being set up and surgeons are more comfortable treating NTOS and Neurogenic Pectoralis Minor Syndrome (NPMS) without supportive nerve conduction studies and cross sectional imaging. The essential role of the physiotherapist in diagnosing and implementing non-operative and post-operative care is put forward, and a summary of management concepts shared.