Thoracic outlet syndrome (TOS) is also known as neck and shoulder syndrome. It refers to a series of syndromes such as pain, numbness, weakness and abnormal sensation in the upper extremity and neck and shoulder caused by different degrees of compression of the brachial plexus nerve and subclavian artery in the thoracic region such as the intercostoclavicular space, the oblique triangle and the pectoralis minor muscle canal due to various anatomical variables. Upper trunk thoracic outlet syndrome: The upper trunk of the brachial plexus caused by factors in the anterior and middle oblique muscles is stuck, resulting in neck and shoulder pain and discomfort, abnormal sensory and motor functions of the upper limbs, and other phenomena, which some people call C56 nerve root entrapment syndrome. It can be classified as neurological, vascular, non-specific or mixed. This disease belongs to the category of “neck and shoulder pain”, “paralysis”, and “impotence” in Chinese medicine, and is caused by strain and wind, cold and dampness. In most cases, strain, trauma, obesity, or other shoulder and neck diseases cause imbalance, inflammatory edema, spasm, and adhesion of the shoulder and neck muscles, resulting in compression of the brachial plexus nerve and subclavian artery. The pathogenesis is based on deficiency of qi and blood, with wind, cold and dampness intermingling and stagnation of blood and stagnation of blood as the symptoms. The “Golden Killing” contains: “blood paralysis” is caused by “disease long into the deep, Ying and Wei of the line astringent, meridians when sparse, so no, the skin does not camp, so it is not benevolent, can be blocked by wind, cold and damp evil for a long time meridians, Qi and blood late stasis and become, blood deficiency does not glory, the meridians lose nourishment. Clinical manifestations: The clinical manifestations vary according to the site of compression and whether the nerve or blood vessel is being compressed. The main manifestations of brachial plexus nerve compression are soreness, discomfort, weakness, coldness, and numbness of the hand. Physical examination may reveal that the muscle strength of the affected limb is slightly poor, and the pinprick pain on the ulnar side of the hand, especially on the medial forearm, is significantly altered, and atrophy of the large and small interosseous muscles may also occur. When the upper trunk is compressed, the main manifestations are shoulder abduction, elbow flexion weakness and muscle strength loss, often accompanied by pain and discomfort in the shoulder and neck, but the passive activities are normal. When the subclavian artery is compressed, the affected limb may become cold, pale with numbness and weakness. When the subclavian vein is compressed, the affected limb is swollen and the hand and forearm may be bruised. When the sympathetic nerve fibers are compressed, in addition to soreness in the upper limbs, there is often Raynaud’s phenomenon, which is manifested as pale and cyanotic limbs, and some patients show profuse sweating of the hands. In addition, some patients with TOS have precordial irritation and neck and shoulder discomfort as the main manifestations. Treatment: Conservative treatment should be preferred for patients with TOS who have neither significant objective signs of nerve compression nor vascular compression causing ischemia of the fingertips or significant swelling of the limbs. The goal of conservative treatment is to increase the space at the thoracic outlet, restore the balance of the neck and shoulder muscles, and gradually eliminate the compression of the neurovascular. Most of the treatment is to correct the patient’s poor posture, and the current treatment mainly includes: oral anti-inflammatory and analgesic drugs, local closure, massage, wet and hot compresses, transcutaneous electrical stimulation, non-steroidal drug treatment and surgery, etc. If in the early stage of the disease, conservative treatment can often lead to rapid improvement of symptoms. 1, small needle knife release method of treatment: find C5, 6 synovial joint most obvious pressure pain points and the subgaleal fossa painful muscle strips (subgaleal muscle, small round muscle), longitudinal and transverse stripping. During the procedure, all patients experience a strong soreness and swelling at the site of the procedure, and most of the soreness and swelling radiates to the back of the shoulder, and in some cases to the lateral elbow, forearm, and even the thumb and index finger. When stripping the painful muscle strips in the infragonal fossa, the muscle contraction under the needle can be obviously felt, and the soreness and swelling can be radiated to the lateral elbow, forearm and tiger’s mouth area. 2, acupuncture therapy: local acupuncture points: take the affected side of the Tian Ding point, distal acupuncture points: according to the disease can be used Fengchi, shoulder well, Tianzong, shoulder three needles, arm creep, hand five li, Quchi, hand three li, external Guan through the internal Guan, each time choose 3 ~ 5 points. When the pain symptoms are heavy, more needles are kept or moxibustion is added. For muscle atrophy, the acupuncture points in this part are selected for electroacupuncture treatment. Once a day, each time 30min, 10 times for a course of treatment. 3.Tui-na therapy: using point analgesia, elastic plucking loose tendons, live joints to restore. First, perform gentle pushing, pinching, pressing and kneading, rolling and other techniques on bilateral oblique muscles, scapularis, supraspinatus, infraspinatus and latissimus dorsi muscles in the neck and shoulder. The direction of rubbing should be consistent with the movement of the muscles as far as possible. Finally, perform acupuncture point manipulation, take Tianzong, Fengchi, shoulder well, Quchi, Hegu and other points. 4.Thermal therapy: the supraclavicular fossa is treated with drug penetrating heat therapy. The formula consists of 30g of Angelica sinensis, 30g of Dog’s back, 20g of Stretching grass, 20g of Wujiapi, 20g of Roasted ginger, 20g of Bonesetter, 20g of Qiangwu, 20g of Dushuo, 15g of Fangfeng, 15g of Gentiana, 15g of Qianxianjian, 15g of Chuanxiong, 15g of Safflower, 15g of Weilingxian, Method: Soak the above drugs and put them in a gauze bag, then put them in a heatable container, add water to the container until the bag is completely soaked. Add water to the container until the bag is completely soaked, then remove the bag after heating and boiling the container, cool it to an acceptable temperature for the patient, and place it on the affected supraclavicular fossa twice a day for about 20 min each time. 5.Closure therapy: Use 0.25%~05% lidocaine 2ml plus tretinoin 1ml mixture for local closure, once a week for 3~5 times. Closure point: dry compression type, vascular compression type often choose oblique angle muscle gap closure; scapular dorsal nerve compression choose cervical 4~5 transverse process with the scapula internal superior angle closure. 6.Hyperbaric oxygen therapy: Large hyperbaric oxygen chamber pressurization 10 ~ 15min, pressure up to 0. 20 ~ 0.25mPa, wearing a mask oxygen, intermittent rest 2 times, 5min each. 7.Acupoint injection: Take acupuncture point: A is point. Medication: compound angelica injection 2 m, vitamin B12 injection 1 ml, get gas, back pumping no blood, the drug will be injected. Third, surgical treatment: The traditional surgical treatment method is 1st rib resection. Cut the anterior and middle oblique muscles at the beginning of C4 and C5 transverse processes, and cut the small oblique muscles at the same time. The oblique angular muscle is cut, and if the cervical ribs or c7 transverse process is too long to affect or directly jam the brachial plexus nerve vessels, surgical excision is performed at the same time. The classic rhomboidotomy is improved by cutting not only the anterior middle rhomboid muscle but also the lesser rhomboid muscle; the facial fibers at the beginning of the anterior middle rhomboid muscle are cut in patients with preoperative combined cervical and shoulder discomfort or decreased shoulder strength; the epicranial membrane of the subclavian artery is stripped and the epicranial membrane of the hypoglossal nerve is released in patients with cold and white extremities. Endoscopic-assisted surgery for upper stem thoracic outlet syndrome.