Objectives: Thoracic Outlet Syndrome (TOS) is a challenging pathology due to its varied and non-specific presenting symptoms that overlap with other neurologic disorders. Neurogenic TOS (nTOS) often has disappointing results following surgical decompression. Our objective is to describe our thoracic outlet clinic where a management algorithm (Figure 1), utilizing a multidisciplinary approach to TOS, has been adopted and to compare our surgical results pre- and post-clinic. Methods: A retrospective review was conducted on patients who underwent thoracic outlet decompression for TOS between 2008 and 2023. Group 1 included patients managed before the clinic was established and Group 2 included those seen afterwards. Data on demographics, presenting symptoms, preoperative workup, length of hospital stay, perioperative complications and surgical approach were collected. Symptom resolution post-operatively was collected based on chart reviews and direct patient contact. Outcomes were classified into three categories: complete, partial, and no resolution. Results: 219 thoracic outlet decompression procedures for TOS who fit the inclusion criteria were performed during the study period: Group 1 included 15% (n=37) of patients and Group 2 included 85% (n=182) of patients. There were no significant differences between the two groups in presenting symptoms, operative approach, hospital stay or complication rates. There was a statistically significant difference in the rate of complete resolution (41% vs 73%, p<0.05) and combined partial and no resolution (59% vs 27%, p<0.05) between Group 1 and Group 2, respectively. Conclusion: TOS is a complex pathology whose workup should follow a standardized algorithm utilizing a multidisciplinary approach. Establishing a thoracic outlet clinic where this approach is applied efficiently can expedite the diagnosis and management of this pathology; ultimately, leading to improved surgical outcomes. Given the success of the multidisciplinary clinic model for the management of TOS, the same principles can be applied to improve the management of other complex pathologies. 
Figure 1. Thoracic Outlet Syndrome Clinic Management Algorithm.
