If you see patients with pain from the neck/shoulder, radiating down the arm and into the fingers, they may have neurogenic thoracic outlet syndrome, or NTOS. Occipital headaches, arm weakness, and chest wall pain often co-exist. This syndrome targets women and can occur after motor vehicle accidents. This is a complex spectrum disorder that provokes controversy. In fact, it may be the most controversial diagnosis in medicine. Yet, the evidence demonstrates that if left untreated, quality of life is impaired as much as having chronic heart failure. We will talk about common symptoms, etiology, diagnosis, and current treatment options including Botox® therapy.