Controversies in NTOS: Inflammation and Symptom Formation in NTOS

  • Wladislaw Ellis


NTOS frequently becomes chronic with spreading and migrating sensory, motor and autonomic dysfunction that is poorly understood. Intraoperative thermography, microscopy, and cytokine staining revealed “innervated fibrosis” of brachial plexus nerve trunks leading to the local presence of pro-inflammatory cytokines. Because similar abnormal, actively secreting growths have been reported in a wide variety of chronic, painful disorders, suggesting a common etiology, we propose a model involving potentially de-differentiated neurites and Schwann cells as well as activated mast cells, macrophages, and fibroblasts to account for symptom formation, progression, and intransigence. This conceptual structure suggests new strategies for better symptom control, including thorough brachial plexus neurolysis at the time of operation, perineural anti-inflammatory treatment, and systemic anti-inflammatory modulation.


Schwann Cell Brachial Plexus Spinal Dorsal Horn Stellate Ganglion Thoracic Outlet Syndrome 
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Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  1. 1.Private PracticeNeurology/PsychiatryBerkeleyUSA

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