[TOS (thoracic outlet syndrome)--a challenge to conservative treatment]

Functional impairment and pain in the upper extremities may indicate a functional deficit in the thoracic outlet. Static work posture, trauma and whiplash injury may be predisposing factors. The younger generation who often spend long hours in front of a computer are in danger of becoming a future risk group. The primary care physician should be familiar with the syndrome which can be identified by careful clinical examination. Timely intervention can prevent much of the disabling symptomatology. Treatment is primarily conservative and should be aimed at the restoration of functional capacity. As in other disorders, the individual constellation of symptoms is dependent on circumstantial factors, an aspect meriting particular attention in treatment and follow-up. Optimisation of ergonomic conditions is important feature of treatment, and long-term follow-up is necessary. Transient exacerbation is not an indication for surgical treatment. If cervical and thoracic outlet function has normalised but the patient still has symptoms, then the differential diagnosis should be reconsidered. Examination and treatment of patients with pain in the upper extremities requires the collaboration of the physician and physical and occupational therapists. Treatment can be delivered in the primary care setting.