The thoracic outlet syndrome. Meeting the diagnostic challenge

Although arm and hand pain, paresthesias, and weakness are common complaints in thoracic outlet syndrome, only a small minority of patients presenting with these symptoms will be found to actually have this condition. Thus, the clinician should be familiar with the symptoms and signs of this syndrome and also be aware of the difficulties of objectively confirming the diagnosis. After a thorough history and physical examination, cervical spine radiographic and electromyographic study may be the most helpful first tests for exclusion of other common conditions causing similar symptoms, such as cervical degenerative arthritis and carpal tunnel syndrome. Arteriography may well be considered next if the patient does not respond to conservative treatment. Only when other, more common illnesses are excluded should the thoracic outlet be surgically explored. Results of surgical therapy should be good, especially if true pathologic compression of the neurovascular structure is present.