Thoracic Outlet Syndrome.

The manifestations of thoracic outlet syndrome vary according to which of the neurovascular structures are affected. To provide optimal treatment, the pathogenesis must be understood in terms of both the anatomic variants and the dynamic factors. The diagnosis is primarily clinical, although ancillary diagnostic studies are useful in selected patients. Following a careful examination, the orthopaedic surgeon should be able to initiate a program of appropriate therapy depending on the nature and severity of the clinical manifestations. Initial treatment is oriented toward postural reeducation and periscapular muscle strengthening. Glenohumeral instabilities and painful upper-limb conditions that cause disuse atrophy must be addressed. Operative treatment is reserved for patients in whom a conservative program has failed and for those with significant neural or vascular deficits. The surgeon must be cognizant of the potential complications of the various procedures used to correct thoracic outlet syndrome. Proper selection of surgical candidates should produce significant improvement in most patients.