Thoracic outlet syndrome

Thoracic outlet syndrome can usefully be regarded as a peripheral entrapment syndrome. Disease processes or anatomical anomalies at the thoracic outlet may in suitable circumstances give rise to compression of neurological or vascular structures traversing the outlet. Investigation involves careful radiological and electrical assessment. Myelography is usually necessary and angiography may be required. Ninety per cent of patients present with neurological complaints and these can normally be managed conservatively. In the 10 per cent of patients who have vascular involvement urgent investigation and early surgery may be necessary if ischaemic complications are to be avoided.