The thoracic outlet syndrome is characterized by a variety of clinical signs due to multiple causes resulting in compression of a neurovascular bundle in a relatively narrow anatomical space. Despite the frequently encountered clinical symptoms, inadequate attention is paid to their analysis, and their diagnostic and surgical aspects require a modern approach. The study included 46 patients. The main clinical sign is a persistent pain syndrome of the cervico-occipital localization that affects the shoulder girdle, suprascapular and infrascapular regions and spreads to the arm in combination with trophic, sensory and vascular disorders. SCT angiography of the superior thoracic outlet structures has been used as a priority instrumental method of research. The macro- and micro factors of compression are the main cause for the development of neurological symptoms, and their removal is the main task of surgical treatment. Surgical approaches were planned depending on the nature and extent of injury. 36 patients underwent 42 surgical interventions. The proper assessment of the neurological status in combination with modern paraclinical diagnostic methods and selection of an adequate surgical approach provided satisfactory outcomes in 33 cases.