Thoracic Outlet Syndrome Surgery: Selecting the Best Surgeon for the Best Outcome

Join Arthur Jenkins, MD for a free, online education event that answers the question, “How do I select the best surgeon and procedure when Thoracic Outlet Syndrome Surgery is necessary.” A noted and compassionate TOS surgeon Dr. Jenkins covers this topic through the lens of his extensive experience helping patients to determine their best choice with regards to TOS Surgery.

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hello i'm dr scott warden the tos guy and i'm live streaming from lake tahoe california and nevada and we are again blessed to have with us dr art jenkins iii who's a great neurosurgeon and a great thinker on tos he's affiliated with two of the best universities in new york now sinai and nyu and today dr jenkins is going to talk about how to select the best surgeon for the best outcome art thanks thank you very much uh scott always pleasure to be here in uh in this tos corner so to speak um this is an area that has um you know come alive in uh in terms of the the number of people who have suffered significantly without getting adequate treatment both from the primary doctors through the pain management doctors to the surgeons it is actually very hard to find the right surgeon for a problem like this one of the issues so first before we get started i i've got no i've got no conflicts of interest to to report i have no uh relationships in industry that are relevant other than the fact that yeah i'm a surgeon i treat tos and so you know take what i say with that grain of salt so what is tos or thoracic outlet syndrome um it is a collection of diagnoses it's no one treatment and no one uh condition which makes it more complicated and some people some some physicians tend to shy away from making diagnoses that are complicated it involves the confluence of the chest the cervical and thoracic spine and the shoulder each of which is an incredibly complicated anatomic area and therefore the confluence of all of these is is is also even more that much more complicated the outlet that we speak about is where the nerves and the neurovascular bundle leave the chest area to go out the arm so the anatomy in particular involves this triangular area here and it involves the nerves it involves the arteries it involves the muscles and involves the bones involves the veins and we're learning more and more that it involves many small structures as well as some of the bigger structures so when you look at the area boundary bounded by all of these structures it it's an overlap of actually multiple specialties as well as multiple clinical diagnoses so and it's because the symptoms vary significantly it's not like sciatica it's not like a pneumonia where people have pretty classic symptoms this is a whole spectrum of neurologic and vascular findings that are often perplexing if you don't understand the primary issues so a lot of patients get kind of kicked around the system there are three different categories of symptoms and syndromes the first we call atos or arterial tos is due to symptoms related to compression on the artery vtos or venous obstruction is obviously from compressions on the veins and then ntos which is the most common type of tos symptom our compression on the various neuro nerves or neurovascular bundle that run through this area causing more primarily neurologic symptoms rather than you know decreased circulation or impingement of circulation into the arm so you can have the the the various uh impingement syndromes and each of which suggests that your treatment should probably be geared towards what the problem is so you can have entrapment by the first rib in between where the normal rib might be you can have impingement where the the one of the chest muscles that controls the position of the shoulder and the shoulder blade the pectoralis minor and these on result when there's instability the shoulder and the shoulder drops down it essentially puts tension on the neurovascular bundle as it goes down and then when the arm goes up the nerves get pinched and bow strung underneath that scalene muscles can sometimes become overgrown especially in people who are doing weight lifting and these muscles have gotten bigger than normal they can pinch nerves between them cervical ribs are a congenital anomaly where you have an extra rib and in some cases you can have an extra rib on each side and these can cause severe pain because they were never meant to be there so this region wasn't designed to have an extra interloper in there so it can pinch the nerves it can even pinch and damage the arteries fibers