Thoracic outlet syndrome: diagnosis and conservative management.

Thoracic outlet syndrome is a condition that has been largely misunderstood. Differing points of view concerning etiology, diagnostic tests, and conservative management are discussed. Historically, vascular factors have been overestimated relative to neurogenic ones. Accurate diagnosis requires reproducing the symptoms by careful patient positioning. Diminished pulse by such maneuvers is not considered significant. Proper treatment requires accurate understanding of the postural factors involved. Most recent programs consider evaluation of joint mobility and muscular imbalance essential. Treatment approaches today place more emphasis on relaxing shortened muscles and less on shoulder girdle strengthening exercises. The importance of patient education is stressed.