A Case of Venous Thoracic Outlet Syndrome: Primary Care Review of Physical Exam Provocative Tests and Osteopathic Manipulative Technique Considerations

Thoracic outlet syndrome (TOS) is a condition that results from the compression of the neurovascular bundle of the upper extremities. It has generally been divided into neurogenic and vascular TOS with vascular further being divided into venous and arterial. This case report is of a healthy 24-year-old female who was misdiagnosed initially in an emergency department only to return two days later for reevaluation. Here, the patient's admission and workup are discussed after she presented to the family medicine clinic for a referral for further evaluation by a cardiothoracic surgeon. Physical exam provocative tests which are often overlooked are reviewed, and osteopathic manipulative techniques and principles are mentioned.