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A D V E R T I S E M E N T
A D V E R T I S E M E N T
A 20-year-old man presented with right arm pain, numbness, hyperemia and paresthesias. He had a positive Adson’s test. Extensive workup failed to demonstrate rotator cuff or other shoulder pathology. There was no cervical rib or other bony malformations on chest X-ray or MRI. Electromyography and nerve conduction velocity studies (EMG/NCV) showed only some delayed conduction in the lateral antebrachial cutaneous nerve. Six months of limited exercise and pain management failed to relieve the symptoms. Because the patient’s occupation involved raising his arms above his head, and the failure of non-surgical management, the patient was taken to the operating room for first rib resection to relieve presumed thoracic outlet syndrome.
A D V E R T I S E M E N T
The superior thoracic aperture (thoracic outlet) is bounded by the first ribs, which connect to the first thoracic vertebra posteriorly and to the sternum anteriorly (see subclavian vein access). A thickened cupola of endothoracic fascia (Sibson’s) attaches to the medial borders of the first ribs and covers the apices of the lungs.
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A D V E R T I S E M E N T
The scalene muscles run between the transverse processes of the cervical vertebrae and the first rib. The anterior scalene attaches to the scalene tubercle on the anterior surface of the first rib, and the middle scalene has a broader attachment starting a few centimeters posterior to the anterior scalene attachment (see superior thoracic aperture anatomy).
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This page was last modified on 5/18/2004.
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