The Hidden Complexity of Thoracic Outlet Syndrome with Dr Scott Werden

Send us Fan MailA patient can spend years chasing an explanation for arm pain, numbness, tingling, or a shoulder that simply stops working under load, only to be told nothing shows up on tests. That gap between lived symptoms and clinical certainty is where thoracic outlet syndrome (TOS) so often falls apart, especially the neurogenic form involving the brachial plexus. I’m joined by Dr Scott Werden, a diagnostic radiologist at Vanguard Specialty Imaging in San Francisco, who has spent decades building better ways to see and explain what is happening at the crowded junction of neck, chest and shoulder. We talk through what thoracic outlet syndrome is in clear terms, why arm motion can dynamically compress nerves, and why standard neurological exams can miss the problem entirely. Scott shares what patients usually endure before reaching the right clinician, plus the controversial tools people lean on, from provocative manoeuvres to selective scalene injections. He also challenges the over-reliance on EMG and nerve conduction studies for early neurogenic TOS, and explains how advanced MRI imaging can shift care from guesswork to an anatomical, treatable plan. Along the way we dig into medical dogma, the history of “disputed” neurogenic TOS, and what a true multidisciplinary model looks like when one clinician quarterbacks input from imaging, physiotherapy, pain management and surgery. If you care about diagnostic accuracy, patient advocacy, sports medicine, or collaborative healthcare, this conversation will sharpen how you think about brachial plexus compression and missed diagnoses. Subscribe, share this with a clinician or athlete who needs it, and leave a review with your biggest takeaway.Guest BiographyDr Scott Werden is a physician and radiologist with Vanguard Specialty Imaging in San Francisco, California. He has spent more than two decades focused on improving the diagnosis and understanding of thoracic outlet syndrome, helping patients and clinicians navigate one of medicine’s most misunderstood conditions. His work centers on advanced imaging, specialist collaboration, and raising awareness to improve outcomes for people living with TOS.LinksWebsite: https://www.tosmri.comLinkedIn: https://www.linkedin.com/in/scottwerden/Subscribe on SubstackVoices in Health and Wellness is published on Substack, as part of The Diagnostician. Every episode lands there with written notes and reflections you won't find in the podcast feed. Free to subscribe.👉 https://thediagnostician.substack.com/s/voices-in-health-and-wellnessAbout the podcastVoices in Health and Wellness features conversations at the intersection of medicine, lifestyle, and human potential, with clinicians, scientists, and thinkers shaping the future of care.About Dr Andrew GreenlandUK-based medical doctor and founder of Greenland Medical, specialising in Integrative and Functional Medicine. Trained in both conventional and root-cause approaches, Andrew helps people optimise health, performance, and longevity, with a focus on cognitive resilience and healthy ageing.