Evaluation of the patient with thoracic outlet syndrome

1. Thoracic outlet syndrome is a clinical diagnosis, based upon patient history, reproduction of symptoms (with arm elevation of 60 seconds and downward pressure on brachial plexus supraclavicularly), tenderness of the scalene muscles, and in the absence of other relevant pathology. 2. The double crush mechanism should be considered in the evaluation of the thoracic outlet syndrome patient, and the patient should be evaluated for concomitant distal sites of compression (i.e., carpal and cubital tunnel syndrome). 3. With a diagnosis of thoracic outlet syndrome, patients should be evaluated to identify muscle imbalance in the cervicoscapular region. 4. The psychological component of pain and associated behavioral responses should be considered in the thoracic outlet syndrome patient, and in some cases, psychologic or psychiatric assessment may be necessary.