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Thoracic Outlet Syndrome or Cervical Radiculopathy?

Updated: Sep 10, 2020


Neurogenic Thoracic Outlet Syndrome (NTOS), which is estimated to account for more than 90% of all TOS presentations, remains elusive in both physical examination and diagnosis. Patients often complain of symptoms that are unrecognizable on X-Ray, MRI, and nerve conduction studies. This can be perplexing for patients seeking an origin to the pain and paresthesia they are experiencing in their upper extremity. Physical exam tests, although still useful clinically, lack the sensitivity and specificity needed to accurately diagnosis this condition.

The parameters of NTOS are not well defined. Entrapment of the brachial plexus can occur in several locations as it courses its way towards the upper extremity. This can make isolating the source of discomfort even more challenging for the clinician. However, there are some hallmarks of this condition that can be insightful and aid in the diagnosis and treatment of NTOS.

5 Simple Tips to Differentiate NTOS from Cervical Radiculopathy

  • Cervical distraction often alleviates paresthesia from cervical origin. With NTOS, distraction may aggravate symptoms due to tensioning of the brachial plexus.

  • The 4th and 5th fingers correspond to the C8 dermatomal dis