TOS Basics: Why is MRI the best choice for diagnosing TOS?

Join Scott Werden, MD as he discusses the value of each type of diagnostic imaging tool when a physician or patient seeks to confirm a Thoracic Outlet Diagnosis.

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don't guess with tos

the tos guy

do I have thoracic outlet syndrome

do I have TOS

and away we go why is mri the best test for diagnosing tos let's review a couple quick things about tos itself thoracic outlet syndrome occurs when there is symptomatic compression of the arteries the nerves or the veins that pass through either thoracic outlet

there are three types of tos because there are three structures that pass through each thoracic outlet there is arterial tos there is venus to s and there is neurogenic tos neurogenic to us accounts for about 95 percent of all tos cases and it is the type that is the most difficult to diagnose by far most cases of neurogenic tos or tos in general have compression of multiple structures and along each structure there can be multiple points of compression let's keep in mind that many different types of tos have been described over 200 years in the literature it's not a homogeneous disease so we have to be prepared for a lot of complexity now the clinical diagnosis of tos that's when your doctor examines you in his or her office it's quite challenging you may have heard of clinical tests that include adson's test the right test halstead maneuver ruse test etc all of these have been shown to be pretty so-so they're not excellent they're not specific they're not sensitive there are many different patients that have many different of these tests that are positive maybe some of them aren't positive so when we say the last point these tests are known to have limited sensitivity and specificity those are just medical research words that say they miss some cases or they overcall some cases that aren't really there so the clinical exam examination should be a starting point it should not be the be-all and end-all let me also remind you as i tell other people i tell a lot of my doctors that the mri isn't by itself or any diagnostic test isn't by itself meant to replace the clinical examination it's meant to work with the clinical examination so your doc suspects you might have tos get you the right kind of imaging and besides diagnosing tos the right kind of imaging can show which type you have i've recorded 25 or 26 different types in the literature before 1956 where a neurology fellow said i'm going to take all this complexity and boil it down and just call it one disease thoracic outlet syndrome his name was pete p-e-e-t that's his last name and his paper states there's all kinds of cases there's all kinds of complexities there's all kinds of causes so let's just call it one disease i believe and i think other docs in the field believe that was a mistake so when we talk diagnosis we're not just talking about confirming your diagnosis we're talking about finding what specifically is going on how would you treat this differently from another case of tos so here's two big questions what do we need to see and what imaging tests do we have all right what do we need to see well the thoracic outlet as i've demonstrated to you before in these talks there are muscles there's fat there's nerves the big brachial plexus there's fibrous bands that show up there's bone there's lung there's also blood vessels and in those blood vessels we have different types of blood flow we can form blood clots and there are finally dynamic changes when you move your arms what happens to your thoracic outlet on each side so those are things we need to see to be reasonably accurate and helpful diagnosing tos and as i said pointing before what type of tus do you have you've seen this picture if you've seen my talks i love showing this picture it's a beautiful pencil drawing done on a computer you can see the muscles the nerves of the brachial plexus the subclavian artery the subclavian vein the bones in between all that is fatty tissue you see the spine this is just a reminder because if you've watched my talks we've gone over anatomy many times so let's switch to what imaging tests we have that's the point of this talk and here's a list of them we're going to go through one by one x-ray everybo

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Please watch: "(1610) NeoVista® MRI for Thoracic Outlet Syndrome: What makes it different? "
   • What Sets Neovista® Mri Apart For Thoracic...  
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