TOS can take many months to develop. A good example is a rock in the shoe. If you place a rock in your shoe and leave it there for a month, you ll adapt your walking and gait around the pain. After awhile, you ll likely develop back pain from walking with a limp. It s because of this phenomenon that there can be several month s delay between the onset of neck pain and TOS symptoms.
Exam is where most practitioners miss the diagnosis.
The problem seems to be due to a compartmentalization of the body by musculoskeletal specialists. Most MD and DO physicians view the body as disconnected areas. A common problem is the axial and peripheral mindset. For example, many doctors without significant soft-tissue training will limit their exam to the areas of complaint. Since many patients complain of hand symptoms, the exam is often focused from the elbow down.