I've had a good experience being diagnosed and treated by Dr. Scott Fried In Blue Bell PA (Southeastern PA, about 19 miles northwest of Philadelphia -- 610-277-1990). He is an osteopathic orthopedist and hand surgeon who specializes in upper extremity nerve injuries (and did two years of post fellowship training with Drs. Hunter and Whitenack at Thomas Jefferson University in the surgery and treatment of thoracic outlet syndrome and brachial plexus injuries). He believes surgery should be a last resort, and believes in both standard and alternative treatment options.

He is very thorough and caring. He will go over your previous medical records, then do a hands-on, thorough exam of your upper body and neck to check for any sort of orthopedic problem as well as specific testing for carpal tunnel, TOS and other nerve problems. His office will also do x-rays of your neck (to check for cervical ribs and any obvious bony neck problems), and wrists (to check for hand and wrist problems).

His physical therapy office will make any splints you may need for wrist or arm problems , as well as provide you with an arm support that Dr. Fried developed if he feels it will help you (it has really helped with my right arm). They also teach you how to perform nerve glides for the affected nerves in your arms (brachial plexus, median nerve, etc.) and gentle stretches, as well as educate you about how to modify arm movements and daily activities to minimize symptoms from TOS and any other nerve problems you may have.

He also has EMG/nerve conductivity studies performed (by an in-house expert) and refers patients to Dr. Baran (a specialist in physical medicine and SSEP nerve testing) for SSEP nerve testing and a second physical exam. From what I understand, SSEP testing checks the sensory nerves, which can show abnormal changes before the nerve is injured enough to show changes in the larger motor nerves that can be detected by EMG/nerve conductivity studies.

He recognizes the need for a team approach to treating TOS and other nerve problems, and refers patients out as needed for pain management, biofeedback, neurology consults, etc. He's referred me to five or six different specialists as needed (pain management doctor for pain medication, neurologist for neurological workup, etc.), who have seemed competent and helpful.

I haven't dealt with headaches from TOS, but the treatment I've received from his office and that of other specialists he's referred me to has greatly improved my pain levels at rest (especially the burning kind of nerve pain) and reduced many of the other distressing symptoms (numb/dead arm, hand flapping up and down uncontrollably at times, feelings of pressure under the arms, etc.) that I experienced before I saw him.

He's also written two books, Light at the End of the Carpal Tunnel and the Carpal Tunnel Help Book. The first book explains the basics of nerve injury in the arms and his philosophy of diagnosing and treating patients with nerve problems, including many anecdotal stories of patients he's treated. I first heard of him when I read this book at the local library.

Hope this helps.

ThreeForOne