Thoracic Outlet Syndrome (TOS) Information

Migraine, carpal tunnel syndrome, reflex dystrophy, dystonia, fibromyalgia, impingement, and thoracic outlet syndrome are clinical diagnoses. They are not pathological ( fascial plane alteration ) diseases. They have a pathological cause. The radiologist must know anatomy to make an accurate diagnosis. You only see what you know!

The terms neurogenic and neurovascular are misconceptions. They are clinical terms. Nerves DO have a blood supply! (arteries, veins, and lymphatics)¹ Image the artery and you image the nerve that binds to the artery for its nutrient blood supply. Research shows, compressing a nerve also compresses the blood supply. Laxity of the sling/erector muscles of the shoulder girdle causes costoclavicular compression². Costoclavicular compression of the bicuspid valves within the draining veins of the neck, supraclavicular fossa with lymphatics, diminishes the blood supply. Any decrease in venous return increases intrathoracic, intracranial, and intraabdominal pressure that triggers TOS complaints³.

Migraine patients with TOS present with upper extremity pain and paresthesias; migrainous headache with or without visual changes (floaters and/or blurred vision); tinnitus; facial, back, chest and leg pain⁴; muscle spasms and dystonia, syncope, hypertension, and upper extremity lymphedema⁵. Some patients present with chronic, debilitating gastrointestinal complaints beyond the nausea and vomiting of the migraine attack and in addition to the usual TOS symptoms⁶.

Dr. James D. Collins monitors bilateral MRI, MRA, MRV brachial plexus at the imaging console without contrast injections and displays landmark anatomy according to grayscale proton density. PA and lateral chest and AP cervical thoracic spine radiographs are acquired prior to the brachial plexus imaging. The functional anatomic series, abduction external rotation (AER) of the upper extremities is the last imaging sequence acquired enhancing sites of costoclavicular compression that triggers patients' complaints. Annotation of the images is the key to undertanding the anatomy.

This is one of many legal landmark cases of Thoracic Outlet Syndrome where the use of bilateral MRI/MRA/MRV brachial plexus imaging displayed one of the anatomic causes of TOS. Leslie S. Caplan and Federal Judiciary US District Court⁷. Her benefits were reinstated.

• Download a video of Dr. James D. Collins of UCLA Radiology annotating and interpreting a sample 3D Brachial Plexus MRI/MRA/MRV of a patient with bilateral Thoracic Outlet Syndrome.

• Visit the 3D Brachial Plexus MRI/MRA/MRV Annotated Image Gallery.

• View a list of physicians and other healthcare providers familiar with treating Thoracic Outlet Syndrome.

• Thoracic Outlet Syndrome Publications, Asbestos Publications, Family Practice Recertification Publications, and Lymphatics Publications from Dr. James D. Collins