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Updated: Aug 19, 2025

Transaxillary First Rib Resection for Treatment of the Thoracic Outlet Syndrome
Published on: September 13, 2020
Anterior Scalene Anomaly in a Patient With Arterial and Neurogenic Thoracic Outlet Syndrome
Dominique L Tucker1,2, Julie Ann Freischlag1
1Department of Vascular and Endovascular Surgery, 12280Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
Abstract:
Compression of the neurovascular structures of the upper extremity as they pass through the thoracic outlet result in thoracic outlet syndrome. The myriad of symptoms associated with the syndrome vary based on the structure(s) compressed: the subclavian artery/vein or the inferior trunk of the brachial plexus. This is a common site of compression especially in the presence of upper extremity injury, overuse or anatomical abnormalities. Majority of patients present with neurogenic pain and weakness; herein, we present the case of a patient with symptoms of both arterial and neurogenic compression caused by aberrant anterior scalene anatomy. These patients are excellent surgical candidates for first rib resection and anterior scalenectomy. A transaxillary approach offers the clinician an adequate window to identify anatomical abnormalities intraoperatively and safely excise the first rib and anterior scalene muscle.
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