Dr. Cherington is a colleague of Asa Wilbourn at the Cleveland Clinic, both well-known for their out of proportion negative responses to TOS. I could quote you extensive articles regarding the ongoing battles between Wilbourn and Roos, but these two have a viewpoint definitely in the tiny minority of medical opinion.

And while there is controversy about aspects of TOS, dismissing a large number of patients by saying, "There is no such thing", and NOT having any alternative diagnosis, does not help patients in any way.

A few key points that Wilbourn and Cherington make:

1. There are no EMG abnormalities in patients with TOS
2. Surgery is done way too often (in their opinion), and therefore must be done only for profit
3. Very few patients with low-paying insurance receive this diagnosis (again, presumable in their opinion as a sign of sinister profit-taking by surgeons)
4. Surgery is only done in one major city (Denver), and is therefore invalid
5. Surgical outcome studies are biased

The counter to these arguments:

1. ALL compressive and entrapment neuropathies have normal EMG's early in the course of the disease. If you wait until the EMG is abnormal, there is a strong chance of permanent nerve damage. Additionally, EMG can not be done in the normal manner when examining a TOS patient, as one probe can not be placed on the proximal part of the nerve being tested (the brachial plexus). EMG abnormalities in other conditions, like carpal tunnel syndrome, can be placed on the nerve on both sides of the compression. Kline at LSU did measure some nerve conductions of the brachial plexus DURING SURGERY, and DID find the appropriate abnormalities.

2. Circular reasoning. Who determines how often surgery is appropriate? If one believes that TOS almost never occurs (a la Wilbourn and Cherington), then ANY surgery is too much. So they make one assumption, then the second merely because the surgery is too often for their first assumption. Weak logic, IMHO.

3. This happens in all of medicine. Patients with low-paying insurance don't get the same care as those with better insurance. The study needs to compare the difference in TOS (between good and bad insurance) with the differences seen in other procedures. Many other procedures are performed more often on patients with paying insurance. If these other procedures see the same differences as those in TOS surgery, than TOS is no different, and this point has no merit.

4. Actually, surgery is done in many, many cities. TOS patients are seen frequently at Harvard Medical School, University of California Los Angeles, University of California San Francisco, Washington University in St. Louis, University of Washington in Seattle, Johns Hopkins in Baltimore.....

Many highly-esteemed medical authorities evaluate these patients on a regular basis. And have published lots and lots of papers from these universities, and around the world. In fact, since the 1960's, over 1700 research papers have been published in peer-reviewed journals (that means that other medical experts say OK or NO to publishing the article), with over 450 articles in the last 10 years alone. Julie Freischlag, MD, who saw 800 patients a year at UCLA for evaluation of TOS, was selected to be the first woman Chair of Surgery at Johns Hopkins (which has won the Best Hospital in the US from US News and World Report for like 12 years in a row). No way Hopkins is going to take anyone but the best, someone with a peerless reputation.

5. Wilbourn and Cherington say that the surgeons who publish all these papers are biased, and recommend an independent panel to review the surgeons' findings before they publish. First, that sounds a lot like an accusation of academic dishonesty. Second, as above, peer-reviewed articles are scrutinized by other experts, so the chances of hundreds and hundreds of papers being faked is pretty remote. Third, nobody who publishes goes through anything like this, INCLUDING Wilbourn and Cherington. So they are trying to dismiss TOS by establishing a completely different standard of research than anyone else uses, INCLUDING Wilbourn and Cherington.


My opinion: They have an agenda, and don't mind leaving out the facts to forward that agenda. Critical reading lends a lot more credence to the existence of TOS, and much more commonly than some would have you believe.

My two cents.