Key Points

• Thoracic outlet syndrome refers to a range of distinct clinical entities resulting from compression of the brachial plexus (Neurogenic thoracic outlet syndrome), subclavian vein (Venous thoracic outlet syndrome) or subclavian artery (Arterial thoracic outlet syndrome)
• The diagnosis of thoracic outlet syndrome requires detailed history and physical exam, diagnostic maneouvers, and often imaging evaluation to outline the pathology affecting the neurovascular bundle
• Initial non-operative management should include modification of activities (at home and at work) to decrease patient symptoms, postural correction, and physical therapy to address the problems of nerve compression and muscle imbalance of the neck and chest wall.
• Surgery is indicated in patients with severe vascular compression or vascular injury, and in brachial plexus compression with symptoms that are refractory to physical therapy.