Thoracic outlet syndrome.

A careful history and thorough physical examination are the most important components in establishing the diagnosis of TOS. The use of radiographic and laboratory tests, when indicated, can improve the diagnostic yield. Provocative positional maneuvers must be evaluated for their vascular and, more important, for their neurologic response. These maneuvers do not "make" the diagnosis, but they can be a useful adjunct for confirming the diagnosis. Vascular TOS is less common and often requires surgical treatment. Neurologic TOS is very common but less frequently requires surgical treatment. The surgical approach and procedure selection should be determined by the nature of the pathologic condition and site of compression.