Neurogenic thoracic outlet syndrome (NTOS) is a chronic neuropathic illness that involves all or part of the brachial plexus. It is predominately a sensory disorder of pain and paresthesias, although it often includes motor dysfunction. Previous trauma(s) create the initial sensory injury of course descriptions A-delta and C-fibers. More recent trauma(s) aggravate the previous injury and impact the central nervous system. Not only is motor function impacted, but the traumas may cause radiation of sensory symptoms beyond the original dermatomes and central sensitization (complex regional pain syndrome II). The pain is unrelenting and grinds on the psyche, particularly if the patient hears or even senses "It's all in your head." The patient may lose his/her identity as a wage earner, parent, or spouse. Happiness and self-image are seriously affected. The effective physician needs to know how the illness has impacted the individual's life and how the individual copes. Recommended therapies must be based on a thorough psychosocial assessment as well as a clinical examination. A biopsychosocial approach is crucial in assessing and treating the patient with NTOS. This presentation will concentrate on 5 areas: 1) anatomy and etiology, 2) symptoms, 3) physical and neurological examination, 4) psychosocial, and 5) laboratory testing and management.