The controversy in the diagnostic workup for patients with suspected NNTOS emanates from the fact that the presentation can be varied and overlaps with many other musculoskeletal issues of the upper extremities. Patients will typically have a history of a hyperextension neck injury, such as whiplash from an automobile accident or a fall to the floor. Also very common is a work-related injury caused by repetitive movements. Predisposing anatomic factors to NNTOS include cervical ribs, anomalous first ribs, and congenitally narrowed scalene triangles. Another common presentation is athletes with repetitive upper limb movements, including swimmers, divers, water polo players, rowers, baseball pitchers, and football quarterbacks . Certainly, this very heterogeneous group of presenting patients will have a wide differential diagnosis, including and not limited to cubital and carpal tunnel syndromes, myofascial pain syndromes, and spinal stenosis.