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. (MRI) of the brachial plexus, using 3-D reconstruction or neurography, can often be helpful in determining localized strictures or deviations of the normal course of the nerves in objectively substantiating abnormalities that point at TOS. Doppler ultrasound, comparing flow with the arm extended and flow with the arm to the side, can also be helpful. Electrodiagnostics are not as helpful, but they rule out other potential causes. I have found thermography to be a very sensitive indicator of abnormal peripheral nerve sensory function/irritation and that it objectively substantiates abnormalities much more frequently than any other imaging modality. In my own series of over fifteen hundred patients with this disorder, there has been a 14:1 female-to-male ratio. In most other series, this ratio varies from 3:1 to 7:1. This disorder has a clear-cut and, as yet, unexplained predilection for women,which has been variously assumed to be due to work choice, poor posture, large breast size, and a penchant for complaining. None of these, in fact, are entirely convincing, although I should note that women with large breasts and TOS do report a moderate decrease in symptoms following breast reduction.