Thoracic outlet syndrome.

Much controversy exists regarding the pathogenesis, diagnosis, and management of thoracic outlet syndrome. The authors review the embryology of several fibroosseous anomalies at the superior thoracic aperture and relate normal and morbid anatomy of this region and the putative roles of anthropomorphic, postural, and dynamic factors to the genesis of neurovascular symptoms. The salient clinical features of this syndrome are described, with emphasis on the peculiar pattern of motor weakness and the physiology of painful symptoms. Diagnostic methods are critiqued. The various surgical approaches for this syndrome are evaluated according to their facility for wide exposure, their potential morbidity, and their beneficial results.