Diagnosis and management of thoracic outlet syndrome.

During the past 15 years, using plethysmography and maneuvers originally described by other researchers, we have tested 1,140 patients who had thoracic outlet symptoms. The vascular compression was recorded noninvasively, which also reflected the pressure on accompanying nerves in the brachial bundle. If the neurologic symptoms were reproduced at this time, the diagnosis of thoracic outlet syndrome was positive. Following exercise treatment (without improvement), 194 patients underwent operative exploration. By performing costoclavicular and hyperabduction maneuvers during axillary exploration, the tissue causing compression was identified and the muscle, bone, or tendon was divided or resected. Division of soft tissues in 180 patients resulted in improvement in the conditions of 173 patients (96%). Bone resection allowed relief of symptoms in six (43%) of 14 patients.