I read with interest the article by Tam and colleagues1 on thoracic outlet syndrome (TOS). As a practising adult neuromuscular/electromyography (EMG) neurologist, I feel true neurogenic TOS is rare. I have seen it in only two cases over eight years in a busy EMG practice.
The authors’ comment that true neurogenic TOS should be managed conservatively is inappropriate when the readership is primarily family doctors. Neurogenic TOS is always treated surgically with sectioning of the fibrous band, which relieves the angulation and stretching of the plexus elements. This relieves pain and paresthesias. However, patients are left with severe hand wasting, given that the presentation is often late. But this surgery stops the progression of hand weakness, and patients may experience some functional recovery of the forearm.2
Footnotes
Competing interests: None declared.