Dr. Giele,

You mention that TOS can result from a variety of structural deviations that are not usually identifiable on MRI. Can TOS result from hypertonic soft tissue (e.g. the scalenes or pectoralis minor) impinging on neurovascular structures? And, if so, given equivocal MRI findings might it be best to first treat a patient with TOS conservatively (e.g. prescription for massage therapy of the accessory breathing muscles) before considering the more invasive option of surgery?

Thank you for your time and I look forward to your response.

Best,
Marco Masci

Competing interests: None declared