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Updated: Feb 28, 2026

Transaxillary First Rib Resection for Treatment of the Thoracic Outlet Syndrome
Published on: September 13, 2020
Thoracic outlet syndrome as a consequence of isolated atraumatic first rib fracture
Aleem K Mirza1, Audra A Duncan1
1Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA.
Abstract:
Neurogenic thoracic outlet syndrome (nTOS) resulting from an isolated first rib fracture is extremely infrequent. We report a case of performance limiting nTOS in a college athlete who was initially evaluated and treated for upper extremity ligamentous injury with only transient improvement. Subsequent noninvasive studies were consistent with TOS physiology and MRA showed a large hypertrophic callus on the first rib adjacent to the brachial plexus. With continued athletic limitations and radiographic findings consistent with TOS, surgical decompression was performed resulting in resolution of symptoms. Although apparent atraumatic isolated first rib fractures are infrequently reported etiologies for TOS in athletes, they are a reasonable consideration in this population with corresponding presentations.
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