Upper thoracic outlet syndrome is an anatomical and functional clinical condition in which there is compression of the nervous and/or vascular structures. The underlying causes can be malformation, post-traumatic consequences, or functional impairments, and often these are inter-related. The clinical diagnosis is obtained through a physical examination, a thorough medical history and evocative tests. This article examines how the different radiological imaging media – radiography, computed tomography, magnetic resonance imaging and ultrasound – can provide the orthopedic or vascular surgeon with useful information to help them identify the cause and location of the problem, and plan a possible surgical intervention to resolve the conflict.