Evaluation of the patient with thoracic outlet syndrome.

Clinical evaluation is paramount in making the diagnosis of thoracic outlet syndrome. Complaints of paresthesia and numbness will relate to the nerve compression component of thoracic outlet syndrome, whereas the pain associated with this syndrome is largely caused by muscle imbalance in the neck, shoulders, and upper back. Utilization of a pain evaluation scale assists in assessing a functional overlay to the pain complaints. Detailed sensory testing at rest and after provocation of the patient's symptoms with overhead activity will assist in the diagnosis. Radiographic test results are frequently normal in this patient population. By contrast, vascular testing results are frequently abnormal in a normal patient population. Electrodiagnostic tests are useful in ruling out other, more distal nerve entrapments.