The brachial plexus nerves emerge between the anterior and middle scalene muscles, and converge with the axillary arteries in the brachial neurovascular sheath lateral to the border of the first ribs. The phrenic nerves pass diagonally downward on the anterior surfaces of the anterior scalene muscles and enter the superior mediastinum. The subclavian arteries usually pass between the anterior and middle scalene muscles. The name changes to axillary artery at the lateral border of the first rib.
The subclavian veins cross the first ribs just anterior to the attachment of the anterior scalene muscles. The medial third of the clavicle is attached to the costal cartilage of the first rib by the insertion of the subclavius muscle and the overlying costoclavicular (Halsted’s) ligament.
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The patient was taken to the operating room for transaxillary first rib resection (Roos) (see also supraclavicular first rib resection). The borders of the latissimus and pectoralis major muscles and the lower edge of the axillary hairline are marked.
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