TOS may arise in a variety of circumstances including trauma, but it may also be seen as a result of postural abnormalities that may be induced by different factors. Cervical ribs and other congenital anomalies are not necessary prerequisites for either the causation or diagnosis of TOS, although they are more common in the TOS population. More important than diagnostic tests are the history and physical examination of the patient. Double crush syndrome can complicate the diagnosis and treatment; however, proper selection of candidates for surgery can produce excellent and good results in a high percentage of cases. Perioperative complications can be significant, so that surgery should be restricted to only those patients who find their symptoms intolerable.

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