Thoracic outlet syndrome: review and reference to stroke in a major league pitcher.

The thoracic outlet compression syndrome is reviewed. It should be considered in all neurologic and vascular complaints of the upper extremity. Symptoms are related to arm position and use and are aggravated by sustained activity that stresses the shoulder. A participant in any sport that requires a repetitive violent throwing motion is a potential candidate for this condition. A detailed report of a major league pitcher illustrates the importance of early diagnosis and appropriate treatment, inasmuch as delay can be catastrophic, as in the case of this career athlete. A thorough history is the best aid in arriving at a diagnosis. When the symptoms are mild or moderate, conservative therapy may suffice. When surgery is indicated, the object is to create adequate space for passage of the brachial plexus, subclavian artery, and subclavian vein. Patients with thrombosis and occlusion of a major artery supplying the upper extremity require an additional arterial reconstructive procedure plus a cervicothoracic sympathectomy.