The condition known as thoracic outlet syndrome is not one thing but the name given to a collection of symptoms, all ascribed to problems with compression of blood vessels or nerves as they pass through the anatomical thoracic outlet. This structure is outlined by the first rib, the collar bone or clavicle and the neck scalene muscles, with the neurological and vascular structures passing through it to reach the axilla and travel into the arm. Diagnosis of these related conditions is difficult and there is little clarity or consensus about them.

The first and vital issue is the correct diagnosis of the injury and its severity as this will dictate the whole course of the treatment and indicate the speed of progression to be expected and the length of time taken until the injury is recovered. Physiotherapy is the main treatment course and the physiotherapist will judge the programme depending on the severity of the injury and how long it is since it has occurred. There are no reliable scientific guidelines for this kind of injury management and rehabilitation so the programme will need to be individually set and adjusted to suit the changing needs of the patient.

Up to the six week point after injury the remodelling phase can be said to occur and by this stage the physiotherapist will test the patient to see if they can contract the hamstring muscle against maximal resistance without pain or anxiety. The physio will then ask the patient to perform isotonic muscle contractions in the prone position with larger number of repetitions and lower weights initially, progressing to higher weights and fewer repetitions if no pain is experienced. It is advisable not to be too fast in increasing the weight and force applied to prevent a recurrent injury or a chronic strain.

One of the most frequent chronic diseases of children and the most common rheumatological condition in this group is juvenile rheumatoid arthritis. This is not one disorder but a group of interrelated disorders which all exhibit inflammatory changes in the joints. The triggering factors for these diseases have not been uncovered and it has proven hard to delineate one particular type of condition from another due to the complex genetic factors. While it is often called JRA, there is a move to standardise the naming of these diseases into juvenile idiopathic arthritis.