Why does it take so long to diagnose thoracic outlet syndrome and why is it so commonly misdiagnosed?

For example... it took 2 months for many top sports physicians to diagnose Markelle Fultz thoracic outlet syndrome.

• For the 2018–19 season, 76ers head coach named Markelle Fultz the starting shooting guard over veteran JJ Redlick. Fifteen games later, Fultz lost the position to Jimmy Butler
• On October 5th 2017 he got a cortizone injection in the shoulder.
• By October 25th he was sidelined for 3 games with the shoulder injury still but no one knew what it was.
• Finally on November 20, 2018, his agent Raymond Brothers announced Fultz would not participate in practice or games until a shoulder injury was evaluated.
• Finally on December 4th 2018 his ailment was correctly diagnosed as thoracic outlet syndrome.

Why did it take so long?

First, its not the fault of the sports physicians. Thoracic outlet syndrome is very difficult to diagnose. It is a fact that patients with thoracic outlet syndrome are the most misdiagnosed, mismanaged, misinformed, and mistreated patients today.

Treatments fail when the treatment is applied to the wrong diagnosis. It is possible that failed attempts at conservative management are related to the wrong diagnosis or in incomplete diagnosis. Keeping it simple, the patient is simply misdiagnosed.

What is even more challenging for you is that the majority of physicians who get the diagnosis right get the cause wrong. Because they don’t treat the cause, even with the right diagnosis the treatment approach is destined to fail.

Many time-strapped doctors today, in all branches of medicine, typically spend 10 to 15 minutes or less with each patient—not because they don’t care, but because there are simply not enough hours in the day to meet the demands for an in-depth examination.

How are doctors supposed to be able to differentiate if you have thoracic outlet syndrome or 30 other conditions that mimic thoracic outlet syndrome? If it’s their area of expertise, it takes an hour to really do a thorough examination.

Here is a list of the 30 different conditions that mimic thoracic outlet syndrome.

1. Herniated disc, bulged disc, slipped disc, sixth nerve root
2. Herniated disc, bulged disc, slipped disc, seventh nerve root
3. Herniated disc, bulged disc, slipped disc, T1 nerve root
4. Cervical radiculopathy, brachial plexus injury, or brachial neuritis
5. Cervical spondylosis
6. Neck trauma
7. Thoracic disc injuries
8. Clavicle injuries—acromioclavicular joint injury
9. Clavicle fracture malunion
10. Inflammatory conditions of the shoulder (tendonitis arthritis)
11. Shoulder impingement syndrome
12. Rotator cuff inflammation
13. Intercostal neuritis (pinched nerve between the ribs)
14. Cubital tunnel compression
15. Carpal tunnel syndrome
16. Guyon’s canal
17. Median nerve entrapment
18. Double crush
19. Triple crush
20. Quadruple crush
21. Vascular diseases (atherosclerosis)
22. Paget-Schroetter syndrome or effort thrombosis
23. Pancoast’s tumor
24. Spinal cord tumor or neoplasm
25. Complex regional pain syndrome (reflex sympathetic dystrophy)
26. Degenerative spinal cord disease—MS
27. Degenerative spinal cord disease—syringomyelia
28. Raynaud’s phenomenon
29. Cervical ribs and fibrous bands
30. Myofascial pain syndrome

All these conditions mimic the symptoms of thoracic outlet syndrome. So, if you only got that 10–15-minute history and examination, and then the doctor made a diagnosis, or if the treatment approach the doctor is using isn’t getting you the results you expected, you might be misdiagnosed.

Also, what really confuses doctors and patients is that you could be underdiagnosed. What that means is that you were diagnosed with carpal tunnel syndrome, but in reality you have carpal tunnel syndrome, median nerve entrapment, rotator cuff tear, and a thoracic outlet syndrome at the same time.

If it’s not the doctors’ area of expertise, and they don’t know what goes into a thorough exam, you’ll probably get 10 minutes of chitchat. If you don’t know some basic anatomy (for example, how the thoracic outlet is engineered, how you should be examined), then a doctor could simply skim over the exam, never touching the area that hurts, and instead order an MRI scan and a referral to a neurosurgeon.

The bottom line is that it is common for patients to be misdiagnosed and even have one, two and three or more surgeries for misdiagnosed conditions such as herniated disc surgery, cubital tunnel surgery, carpal tunnel surgery and/or lengthy treatment stints that go on and off for years before someone finally says, Could it be thoracic outlet syndrome?

By that time they have more pain from the surgeries they did not need, the agonizing symptoms of the untreated chronic thoracic outlet syndrome and a cloud of depression and lack of hope on top of it.

If it took the nations top sports team physicians two months to properly diagnose this top professional athlete with thoracic outlet syndrome dont be surprised if you were misdiagnosed and mistreated.

Dont you wish there was a way to fact check your doctor’s diagnosis?

By becoming educated on TOS you can fact check your doctor’s diagnosis so you dont waste time with treatments that will never work or worse, get hand, elbow, shoulder or neck surgery that you never needed.

Well, in this chapter 9 of Dr Stoxen's book, we review each of the 30 different diagnoses that could be considered with your array of symptoms and give you tips on how you can differentiate between each of them and thoracic outlet syndrome.

This is an excerpt from Dr Stoxen’s #1 best seller The Human Spring Approach to Thoracic Outlet Syndrome. The book is available on Amazon.com in these counties US UK DE FR ES IT NL JP BR CA MX AU IN on Kindle. The book is available on Amazon.com in these counties US UK DE FR ES IT JP in paperback.

Order your copy and start reading and healing today.