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Diagnostic accuracy of physician and self-referred patients for thoracic outlet syndrome is excellent.
[thoracic outlet syndrome]
The
purpose
of
this
study
was
to
categorize
patients
referred
to
a
specialized
thoracic
outlet
syndrome
(
TOS
)
practice
to
determine
the
diagnostic
accuracy
of
those
who
are
physician
and
self-referred
.
Demographic
and
clinical
data
on
all
patients
who
were
referred
for
TOS
between
2006
and
2010
were
retrospectively
reviewed
from
a
prospectively
maintained
institutional
review
board-approved
database
and
patient
records
.
Between
2006
and
2010
,
621
patients
were
referred
for
TOS
(
433
women
and
188
men
;
mean
age
39
Â
years
[
range
10
-
87
]
)
.
Five
hundred
seventy-
one
patients
(
92
%
)
were
diagnosed
with
TOS
,
with
421
(
74
%
)
neurogenic
,
126
(
22
%
)
venous
,
and
24
(
4
%
)
arterial
TOS
cases
.
Of
the
525
physician
referrals
,
478
(
91
%
)
had
TOS
,
and
of
the
93
self-referrals
,
90
(
97
%
)
had
TOS
.
The
421
patients
with
neurogenic
TOS
(
NTOS
,
304
women
and
117
men
)
had
symptoms
on
average
for
56
Â
months
(
range
1
-
516
)
.
Two
hundred
seventy-
one
patients
(
64
%
)
were
initially
treated
with
TOS
-
specific
physical
therapy
(
PT
)
,
and
100
(
37
%
)
improved
.
One
hundred
seventy-
eight
patients
(
42
%
)
underwent
a
lidocaine
block
,
and
145
patients
(
81
%
)
had
a
positive
block
.
Seventy
-
four
patients
(
18
%
)
underwent
Botox
injections
44
(
60
%
)
of
which
were
positive
and
the
average
number
of
Botox
injections
was
1
.
3
.
One
hundred
forty
patients
(
33
%
)
underwent
transaxillary
first
rib
resection
and
scalenectomy
(
FRRS
)
,
and
128
patients
(
91
%
)
improved
.
Of
patients
undergoing
FRRS
,
92
(
66
%
)
had
a
lidocaine
block
,
82
(
89
%
)
of
which
were
positive
.
Of
patients
with
a
positive
lidocaine
block
,
74
(
90
%
)
improved
after
FRRS
.
Of
patients
undergoing
FRRS
,
31
(
22
%
)
underwent
Botox
injections
,
15
(
48
%
)
of
which
were
positive
.
Of
patients
with
a
positive
Botox
block
,
14
(
93
%
)
improved
after
FRRS
.
Average
length
of
time
between
initial
visit
and
operation
was
6
.
4
Â
months
(
range
2
Â
weeks
to
34
Â
months
)
,
and
average
follow-up
time
was
13
Â
months
(
range
1
Â
week
to
49
Â
months
)
.
1
)
Both
referring
physicians
and
patients
are
very
accurate
in
their
preliminary
diagnosis
of
TOS
(
neurogenic
,
venous
,
or
arterial
TOS
)
.
2
)
In
a
specialized
TOS
practice
,
two
-thirds
of
patients
are
sent
to
TOS
-
specific
PT
and
one
-
third
improve
from
this
treatment
alone
.
3
)
One
-
third
of
patients
referred
for
NTOS
eventually
undergo
FRRS
with
a
91
%
success
rate
.
Diseases
Validation
Diseases presenting
"transaxillary first rib resection"
symptom
thoracic outlet syndrome
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