UCSD Center for Thoracic Outlet Syndrome

Thoracic outlet syndrome is a painful condition affecting the nerves and/or vessels that course from the base of the neck to the shoulder and arm through a narrow passageway. The complex of nerves that is often affected in this condition is called the brachial plexus. Patients typically experience pain in the neck and shoulder often radiating into the arm and hand (usually the last two fingers). Symptoms are generally worse with activity and with the arms overhead. Patients with this condition are often initially presumed to be suffering from a cervical spine problem or a pinched nerve in the arm, instead of thoracic outlet syndrome. Thoracic outlet syndrome can be a difficult disease to diagnose. Nerve studies often do not reveal the cause and many healthcare providers are not experienced in making the diagnosis.

The most critical first step in the treatment of this problem is having an accurate diagnosis and knowing where to go to get the best treatment. The UCSD Center for Thoracic Outlet Syndrome has a multi-disciplinary group of physicians who are experts in the diagnosis and treatment of thoracic outlet syndrome. Advanced techniques are available at UCSD to diagnose this disorder, including detailed nerve conduction studies done with moving the arm into positions which re-create the symptoms. Additionally, sophisticated MRI imaging techniques are used to visualize the affected blood vessels, nerves, and adjacent structures with precision and accuracy to pinpoint the cause of pain.

Once a correct diagnosis has been made, your physician at UCSD will come up with a treatment plan that is right for you. Many patients will experience relief of symptoms with a sufficient course of physical therapy that is directed to the treatment of the underlying problem. This requires a knowledgeable physical therapist who has experience in treating TOS. Sometimes medications may be needed to control the symptoms. When the condition is more severe or abnormal structures are present, surgery may become an important part of the treatment. This requires an experienced surgeon who specializes in the treatment of thoracic outlet syndrome. The UCSD Center for Thoracic Outlet Syndrome, and its multi-disciplinary group of physicians with expertise and special interest in treating TOS, is dedicated to providing the best care to patients affected with this condition.
The multi-disciplinary group at The UCSD Center for Thoracic Outlet Syndrome consists of the following:

Dr. Afshin Karimi is a radiologist who has developed superb techniques for visualizing nerves to determine the source of nerve-related pain.

Dr. Geoffrey Sheean is the director of the UCSD Neuromuscular Division. He is known for his expertise in performing and interpreting nerve conduction studies (NCS) and electromyography (EMG) in the analysis of nerve and muscle function. He is able to provide neurophysioloigcal studies beyond the traditional nerve conduction study to identify atypical sources of nerve pain, and distinguish between thoracic outlet syndrome and other similar, but distinct, syndromes.

Dr. Gregory Polston is a pain medicine specialist who performs minimally invasive procedures that target nerve-related pain, which can have an important role in the diagnosis and treatment of thoracic outlet syndrome.

Dr. Natalie Voskanian is a sports medicine physician with special interest in thoracic outlet syndrome. She trained at UCLA where she gained experience treating many athletes affected with this condition. She values the importance of making an accurate diagnosis, coming up with a personalized treatment plan, and returning patients back to their active lifestyles as quickly as possible.

Dr. Justin Brown is a neurosurgeon and surgical specialist in the treatment of peripheral nerve pain disorders. He has had advanced training in thoracic outlet syndrome and has a special interest and expertise in the treatment of this condition.

Dr. Golts is a thoracic surgeon, who treats the vessels of the thoracic outlet

Dr. Jeffrey Gertsch is an interventional neurophysiologist who often assists during thoracic outlet decompression surgery by continuously analyzing nerve function to ensure there is no damage to the neural structures of the brachial plexus.

This multi-disciplinary team of physicians at The UCSD Center for Thoracic Outlet Syndrome is able to provide the most thorough and comprehensive treatment of thoracic outlet syndrome. So whether the source is surgical, medical, or posturally-related, UCSD has answers for those suffering with TOS-related pain.


Justin Brown, M.D.
http://neurosurgery.ucsd.edu/justin-brown-md/
http://plexus.wustl.edu/surgery%5Cneuro%5Cwebsite.nsf/attachments/forms/$file/BrownCV.pdf
http://dev18.caretechsolutions.com/Video/View.aspx?id=4575&sid=2&videoID=136

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