Hypertrophic Non-union of the First Rib Causing Thoracic Outlet Syndrome: A Case Report

Abstract

We experienced a rare case of thoracic outlet syndrome caused by hypertrophic nonunion of the first rib. A diagnosis was made mainly upon provocative tests and imaging studies. Pain and tingling could be reproduced and the radial pulse obliterated by the hyperabduction test. Abundant callus formation on the posterior aspect of the first rib with fracture line was visible on plain radiograph. Two-dimensional computed tomography showed right thoracic outlet narrowing mainly caused by the mass-effect of the callus. Dynamic arteriographic studies revealed an external compression of the right subclavian artery and duplex ultrasonography demonstrated a reduction in right subclavian artery blood flow when the shoulder is in 90 degrees of abduction. Surgery was performed after the conservative management for three months which failed to relieve the patient of his complaints. Resection of the first rib via transaxillary approach was undergone uneventfully in combination with the myotomy of the scalenus anticus muscle. At postoperative one year follow up, the patient was free of symptoms, and had a full range of motion of the right shoulder with no evidence of arterial insufficiency.

Skeletal deformities in wild and farmed cleaner fish species used in Atlantic salmon Salmo salar aquaculture

“…Suh et al . (2001) reported a hypertrophic nonunioned rib fracture with abundant callus formation and radiological appearance similar to that later found in haemal spine calluses in wild M. aeglefinus (Jawad et al ., 2018) and in ribs, and haemal and neural spines of the currently inspected wild L. bergylta . Hence, in fish, the repetitive stress caused by body undulation during swimming and ingestion of large hard particles may cause site‐specific chronic mechanical stress and stress fractures that develop into nonunions caused by impaired callus formation.…”

Nonunion of a first rib fracture causing thoracic outlet syndrome in a basketball player: A case report

“…The problem in this patient was caused by reduction of the costoclavicular space due to the hypertrophic callus arising from the first rib. There have been a few case reports of nonunion of first rib fractures causing TOS, 4,12,13 but no reports of a first rib hypertrophic callus due to nonunion causing TOS in athletes.…”

“…2,3,6-11 If complications are present after conservative therapy, however, resection of the first rib may be necessary. 4,12,13 In this patient, we selected a transaxillary approach because it provides good exposure for resection of the first rib with an excellent cosmetic result compared with the supraclavicular approach. Transaxillary rib resection is a safe and effective procedure and allowed trouble-free resolution of the problem with adequate attention to neurovascular damage and pleural damage in this patient.…”

“Double cervical rib with uncommon presentation”

“…There have been several reports of Thoracic Outlet Syndrome (TOS) caused by malunion of clavicle or first rib [3][4][5] and rare pathologies of the first rib including fusion of first and second rib, tumours like conditions 6,7 secondary to presence of rudimentary or non-union of the first rib [8][9][10] .…”