Thoracic outlet syndrome

Thoracic outlet syndrome (TOS) should no longer be considered a single entity. The syndromes are venous (V-TOS), arterial (A-TOS) and neurological (N-TOS), but may co-exist.Paget Schroetter syndrome or effort thrombosis of the subclavian vein should be recognized early so that younger sportsmen and musicians can be offered the opportunity of lysis, surgery and venoplasty.Most uncomplicated cases of A-TOS and N-TOS can be treated conservatively with posture, diet and physiotherapy advice and reassurance.Complicated arterial TOS, with aneurysm or emboli, should be treated expeditiously by cervical rib excision and arterial reconstruction.Double crush syndromes are relatively common. It is easier to treat carpal tunnel syndrome than N-TOS. Muscle wasting and pain are an indication for surgery in N-TOS.