Diagnosing thoracic outlet syndrome.

Diagnosing and treating thoracic outlet syndrome can be challenging and frustrating. It must be emphasized that the diagnosis of TOS is a clinical one based on a detailed history and physical examination. This takes time and effort and is often confounded by the patient's research on the internet and emotional problems usually resulting from the symptoms and lack of appropriate treatment. Years of inappropriate diagnosis and ineffective therapy take a heavy toll on these patients. Some have psychologic problems to the point that no treatment, no matter how well indicated, will make them well. Some have had symptoms so long that there is permanent neurologic damage. Each patient presents his or her own diagnostic challenge. Solving the problem and providing effective therapy can be rewarding for doctor and patient.