Hi Walker,

Some tests are required in order to rule out other possible dx's, chest x-rays are usually done first off, not only to check for cervical ribs but to rule out abnormally long C-7 projections, and to check for tumors that could be compressing the brachial plexus, for instance. EMG/NCV's can be useful if nerve damage has already occurred that can be picked up by the equipment, an abnormal EMG often speeds up your access to Drs and treatment, including surgery. The one that is considered most indicative of TOS is called the C8 ulnar nerve root study across the brachial plexus. You may need to look for a neurologist at a university or large teaching hospital who has the training to do this.

Have you ruled out any vascular involvement? Doppler studies, done lying down and in positions that sx occur can be helpful.

At this time the tests are still lacking in precision - bone is easily seen but soft tissue just does not show up as well. The best TOS surgeons gather all the info they can from tests, but also depend on a very thorough clinical exam - amazingly thorough. Once they get in the OR and see the situation first-hand though, it is their experience of having done hundreds of these surgeries that allows them to quickly recognize what is causing the problems you are experiencing.

I can't stress enough the importance of choosing a Dr with a great deal of experience, who has a good reputation among former patients, and whom you personally trust and feel comfortable with. Don't settle for anything less because it's more convenient, or someone else thinks you should, or you've been through lots of surgeries before. You deserve the best surgeon working around your nerves!

beth