Barw Barw Medical Journal 2960-1959 2025 11 22 Divergent Conceptualizations and Management Strategies for Neurogenic Thoracic Outlet Syndrome: A Qualitative Multispecialty Study 27 32 10.58742/bmj.v4i1.215 eng Fahmi H. Kakamad College of Medicine, Department of Clinical Sciences, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq. fahmi.hussein@univsul.edu.iq Saywan K. Asaad Department of Orthopedic, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. saywan.asaad@gmail.com Abdullah K. Ghafour Department of Orthopedic, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. abdullah.ghafour@gmail.com Azad Star Hattam Department of Neurosurgery, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. azad.hattam@gmial.com Lawand Ahmed Sharif Department of Orthopaedics and Traumatology, Shorsh General Hospital, Sulaymaniyah, Iraq. lawand.ahmed@gmail.com Hiwa S. Namiq College of Pharmacy, Department of Basic science, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq. hiwa.namiq@gmail.com Rzgar H. Abdul Department of Neurology, Shar Teaching Hospital, Malik Mahmud Ring Road, Sulaymaniyah, Iraq. rzga.abdul@gmail.com Zana Omar kak Abdullah Department of Neurology, Shar Teaching Hospital, Malik Mahmud Ring Road, Sulaymaniyah, Iraq. zana.abdullah@gmail.com Soran S. Raoof Department of Orthopedic, Smart Health Tower (Raparin Branch), Karux Street, Rania, Iraq. soran.raoof@gmail.com Sakar O. Arif Department of Radiology, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. sakar.arif@gmail.com Nsren S. Sabr Department of Obstetrics and Gynecology Radiology, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. nasren.sabr@gmail.com Choman S. Omer Department of Radiology, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. choman.omer@gmail.com Lawen J. Mustafa Department of Rheumatology, Sulaimani Directorate of Health, Sulaymaniyah, Iraq. lawen.mustafa@gmail.com Yousif Khalil Ibrahim Department of Neurology, Shar Teaching Hospital, Malik Mahmud Ring Road, Sulaymaniyah, Iraq. Yousif.Ibrahim@gmail.com Berun A. Abdalla Department of Scientific Affairs, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. berun.anwer95@gmail.com Shvan H. Mohammed Kscien Organization for Scientific Research (Middle East Office), Hamdi Street, Sulaymaniyah, Iraq. shvanh80@gmail.com 2025 09 15 Background Neurogenic thoracic outlet syndrome (nTOS) is the most prevalent subtype of thoracic outlet syndrome and remains one of the most controversial conditions in peripheral nerve and thoracic disorders. Despite widespread recognition of conservative therapy as initial management, substantial variation exists across medical specialties regarding diagnosis, duration of nonoperative treatment, and indications for surgery. These discrepancies suggest underlying differences in how nTOS is conceptualized rather than disagreement over available treatment options. Objectives This study aimed to explore and compare the perspectives of different medical specialties on the management of confirmed nTOS, with particular attention to conservative therapy, surgical indications, and underlying explanatory models. Methods A qualitative descriptive study was conducted using semi-structured interviews with 40 physicians from five specialties involved in nTOS care: thoracic and vascular surgery, neurosurgery, orthopedic surgery, neurology, and rheumatology (eight participants per specialty). Participants were recruited using purposive sampling based on clinical experience with nTOS. All interviews centered on a standardized question addressing management strategies following confirmation of nTOS. Data were analyzed using reflexive thematic analysis. Results Five overarching themes emerged. All specialties endorsed physiotherapy as first-line treatment, though recommended duration varied widely. Profound disagreement existed regarding the role of surgery, ranging from early operative intervention to complete rejection. Surgeons tended to frame nTOS as a mechanical compression disorder, whereas neurologists and rheumatologists frequently expressed diagnostic skepticism and favored prolonged conservative management. Orthopedic surgeons adopted selective surgical strategies focused on musculoskeletal contributors. Across specialties, variability was driven primarily by differing conceptual models of nTOS rather than by technical considerations. Conclusion Management variability in nTOS arises chiefly from divergent understandings of the condition itself. Without addressing these foundational differences, inconsistency in care is likely to persist. Interdisciplinary consensus-building that integrates anatomical, neurological, and pain-based frameworks is essential for developing coherent, patient-centered management pathways for nTOS.