Thoracic outlet syndromes: a non-surgeon's perspective for those caring for musicians

The author reviews the history and clinical presentations of several distinct clinical conditions which together make up the group of patients referred to generally by the term 'thoracic outlet syndromes.' Although in specific cases the anatomy and pathophysiology of these patients correlate well, in most of them, those with the so-called 'disputed neurogenic' form, no such correlation has ever been proven. Thus, treatment of these patients is controversial. In the appropriately cautious management of these patients, surgical decompression of the thoracic outlet should never precede a trial of aggressive conservative therapy. This precept is particularly critical in musicians, because these patients require maximal degrees of mechanical freedom to play their instruments.