Abstract
Background
Thoracic outlet syndrome is an uncommon cause of upper extremity neuropathy resulting from either neurogenic or vascular compromise in the thoracic outlet. Congenital anomalies as the cause of this disease process represent a minority of cases, and the literature regarding their surgical management is still evolving.
Case Report
A 42-year-old female without any relevant history presented to a clinic for evaluation of worsening neuropathic symptoms in the upper left extremity. Initial physical exam was unremarkable, and MRI identified an anomalous first rib, but no abnormality of the brachial plexus. The patient was managed conservatively for almost 4 years before symptoms became debilitating. Physical exam at that time found atrophy and weakness in the muscles supplied by the upper trunk of the brachial plexus, and CT demonstrated anomalies of the bone and brachial plexus not apparent on previous MRI. Neurolysis with local resection of the abnormal bone led to successful resolution of the patient’s symptoms.
Conclusion
Identification of a rare congenital anomaly allowed for a precise surgical treatment of the condition. The importance of careful selection of modality and review of imaging in diagnosis and operative planning is discussed.
References
Baumgartner F, Nelson RJ, Robertson JM. The rudimentary first rib: a cause of thoracic outlet syndrome with arterial compromise. Arch Surg. 1989;124(9):1090–2.
Hashimoto H, Nikaido Y, Kurokawa S, Miyamoto K, Sakaki T. Thoracic outlet syndrome due to first rib anomaly: a case report. No Shinkei Geka. 1994;22(11):1063–6.
Sanders RJ, Hammond SL. Management of cervical ribs and anomalous first ribs causing neurogenic thoracic outlet syndrome. J Vasc Surg. 2002;36(1):51–6.
Ozoa G, Alves D, Fish DE. Thoracic outlet syndrome. Phys Med Rehabil Clin N Am. 2011;22(3):473–83. doi:10.1016/j.pmr.2011.02.010.
Huang JH, Zager EL. Thoracic outlet syndrome. Neurosurgery. 2004;55(4):897–903.
Brantigan CO, Roos DB. Etiology of neurogenic thoracic outlet syndrome. Hand Clin. 2004;20(1):17–22.
Sharan D, Moulton A, Greatrex GH, Das SK, Whiteley AM, Srivastava VM. Two-surgeon approach to thoracic outlet syndrome: long-term outcome. J R Soc Med. 1999;92(5):239–43.
Conflict of interest
Douglas T Hidlay declares that he has no conflict of interest.
R Scott Graham declares that he has no conflict of interests.
Jonathan E Isaacs declares that he has no conflicts of interests.
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All potentially identifying information from this case report has been removed.
This article does not contain any studies with human or animal subjects.
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Hidlay, D.T., Graham, R.S. & Isaacs, J.E. Anomalous first thoracic rib as a cause of thoracic outlet syndrome with upper trunk symptoms: a case report. HAND 9, 484–487 (2014). https://doi.org/10.1007/s11552-014-9621-2
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DOI: https://doi.org/10.1007/s11552-014-9621-2