Recognising and managing thoracic outlet syndrome in primary care

Thoracic outlet syndrome (TOS) remains a diagnostic enigma in general practice.Although it is an uncommon cause of upper limb symptoms, its potential to cause chronic pain and disability means it should be considered when more common conditions do not fit the clinical picture.In primary care, management should be optimised to limit specialist referrals to those who truly need them.TOS has three subtypes: neurogenic (nTOS); venous (vTOS); and arterial (aTOS).Over 90% of cases are neurogenic (brachial plexus compression), 1 whereas the vascular subtypes are far rarer but can present acutely and require urgent management.Vascular cases are typically referred directly to vascular surgery, whereas nTOS often follows an insidious course with symptoms that are subtle, non-specific, and easily misattributed to other conditions.