Controversies in NTOS: Is NTOS Overdiagnosed or Underdiagnosed?

The topic of this chapter is to address the rhetorical question, “Is neurogenic thoracic outlet syndrome (TOS) overdiagnosed or underdiagnosed,” and the answer depends a great deal on the experience of a given physician, medical center, or geographic location. The necessity of a multi-disciplinary team to improve the diagnosis and treatment of this difficult condition renders a variety of situations with regard to the question at-hand. For example, if a physician is in solitary practice or isolated geographically, it is very unlikely that they will “overdiagnose” neurogenic TOS unless they happen to know a great deal about it (from some form of unique previous exposure in training or practice), have it themselves, or something similar. On the other hand, if he or she is a member of a large primary care or ­multidisciplinary group, or one of several referring ­specialties (such as thoracic surgery, cardiovascular surgery, neurology or neurological ­surgery, orthopedic surgery or sports medicine, physical medicine and rehabilitation, pain management medicine, psychiatry, cardiology, internal medicine or general practice), the diagnosis of neurogenic TOS may well have been regularly considered in a differential diagnosis and this condition may even have been even “overdiagnosed.”