Thoracic outlet syndrome: a hard problem in diagnosis and management

Thoracic outlet syndrome presents a diagnostic and management challenge to general practitioners, physicians and surgeons alike. It is classified into three general categories depending on the specific structure believed to be impinged at the thoracic outlet (vein, artery or nerve), all of which involve pain in the upper extremity. The principles of management generally involve a stepwise escalation from conservative measures such as physiotherapy, activity and posture modulations in addition to analgesic medications before surgical decompression of the thoracic outlet is considered. Vos et al. (1) in their review article have described the different approaches in the most commonly used form of surgical decompression of the thoracic outlet 1st rib resection.