Therapist management of thoracic outlet syndrome.

Treatment of the thoracic outlet patient can be a complex and challenging problem for the occupational or physical therapist. The literature supports conservative care as the preferred approach for these patients; therefore, therapy plays an important role in caring for these patients. I question whether TOS is becoming the RDS of the 1990s. Often these "TOS" patients are suffering from additional secondary system complaints including active myofascial trigger points, primary or secondary glenohumeral joint pathologies, cervical pathology, or more distal peripheral neuropathies. A thorough evaluation by the therapist is extremely important in determining TOS and separating compressive TOS from entrapment TOS. It is only after a thorough assessment that a proper treatment approach can be formulated. Treatment should initially address comfort, control, and relief and then progress to the neurovascular component. Finally, strengthening and conditioning, if tolerated, are implemented. Properly educating the patient to achieve behavior modification, exercise compliance, symptom control, and postural correction is requisite to optimal results.