Thoracic outlet syndrome secondary to a mid-clavicle malunion

A 22-year-old man presented with a painful 'clunking' sensation in the right mid-clavicle, and pain and dysaesthesia along the medial aspect of his right arm and hand. Three months earlier, he had been involved in a vehicle accident and sustained a right clavicle fracture. He had a large step off of the right clavicle with a medialisation of the right shoulder. At 90° abduction in external rotation of both shoulders he developed pain, paraesthesia and disappearance of the right radial artery pulsation. CT of the right shoulder in the neutral position demonstrated the clavicle-to-first rib distance of 5.5 mm, MRI showed the clavicular bone callus had a mass effect with effacement of anterior fat adjacent to the brachial plexus cords. He was diagnosed with thoracic outlet syndrome and underwent a corrective right clavicle osteotomy with the use of an AcuMed superior clavicle plate.