Divergent Conceptualizations and Management Strategies for Neurogenic Thoracic Outlet Syndrome: A Qualitative Multispecialty Study
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…
2025 610 reads 0 citations
Original Articles
Divergent Conceptualizations and Management Strategies for Neurogenic Thoracic Outlet Syndrome: A Qualitative Multispecialty Study
BackgroundNeurogenic 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.
MethodsA 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.
ResultsFive 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.
ConclusionManagement 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.
Keywords Reflexive thematic analysis Qualitative study Conservative management Clinical conceptualization Interdisciplinary care Surgical decision-making All subjects
Barw Medical Journal. 2025;3(5):27–32