Presentation on

Thoracic Outlet Syndrome

by

Dr James Stoxen DC

Dr James Stoxen's Bio

Presented at the
12th Annual World Congress on Anti-aging Medicine

Mandalay Bay Hotel and Casino, Las Vegas Nevada
 December 4, 2004

A presentation of the most effective diagnosis, treatment and prevention of

Thoracic Outlet Syndrome (TOS)

Chapter III of IX
Thoracic Outlet Syndrome is controversial in the medical community. 

Thoracic Outlet Syndrome is controversial in the medical community. 

Here is why...

      Underdiagnosed or Overdiagnosed

Some physicians say that this syndrome is under-diagnosed.  I read a letter to the editor in a surgical publication, which said that this physician said it was under-diagnosed and that more thoracic outlet syndrome actually existed, while other physicians say it was over-diagnosed.  We say that it is under-diagnosed. 

     No Gold Standard Test Exists 

The problem with this syndrome and the difficulty with this syndrome that many physicians have is that there is no gold standard test for thoracic outlet syndrome.  In order to diagnose thoracic outlet syndrome you have to put together an array of historical findings, physical findings and a couple of provocative orthopedic tests in the region of the neck and shoulder to be able to make that diagnosis.

     Most common Treatment is Surgery 

The most common treatment today is surgery.  According to the literature, if you have a group of 500 patients only 10% will respond to conservative therapy, which leads to 90% going to surgery.  Doctors oftentimes give up on initiating conservative therapy and go directly to surgery.  We have to put ourselves in the position of the patient.  If you can see on this graphic here we have a surgery of the neck.  There are many tiny important structures in this area.  Patients are in great fear of surgery, especially in the neck so the answer is no patient wants to have this surgery

     Surgery is unnecessary with the right approach 

We have a very high rate of recovery from thoracic outlet syndrome with conservative care, and I am very happy to present that form of treatment to you today.  I have not referred a patient for surgery for a thoracic outlet syndrome in 18 years of practice.  That includes thousands of patients over these 18 years.  I was very shocked when I looked into the literature.  I was aware of the rhizectomy, removal of the first rib.  I was curious about other therapies so I reviewed over 325 scientific papers that discussed conservative methods of therapy, including stretching and what the procedures and protocols were used to treat these patients conservatively.

     Why Current Conservative Therapy is Unsuccessful           

I think that after my presentation today, you will find out why these treatments were unsuccessful.  You are going to have a better understanding of the most common cause of this syndrome.  I feel that with a better understanding of what causes this syndrome, you will have better results with conservative therapy of this syndrome. 

Table of Contents

Chapter I            Dr Stoxen's Introduction                                  Read it here...

Chapter II          Anatomy of Thoracic Outlet Syndrome          Read it here...

Chapter III        Thoracic Outlet Syndrome Controversy         Read it here...

Chapter IV         History or Patient Presentation                      Read it here...

Chapter V           Physical Examination Findings                       Read it here...

Chapter VI         Diagnostic Tests for TOS                                  Read it here...

Chapter VII       Treatment of Thoracic Outlet Syndrome       Read it here...

Chapter IX         Case Histories of Patients with TOS