Thoracic outlet syndrome: a rare case with bilateral cervical ribs and bilateral anterior scalene hypertrophy

Farina, R.; Foti, Pietro Valerio; Iannace, Francesco Aldo; Conti, Alessio; Ferlito, Agata; Conti, Alessandro; Pennisi, Monica; Santonocito, Serafino; Basile, Antonio

doi:10.1007/s40477-019-00418-w

Cited by 10 publications

(6 citation statements)

References 18 publications

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“…[ 10 ] The US of the subclavian vein should be performed in the costoclavicular space which is the anatomical space formed inferiorly by the first rib, superiorly by the clavicle, and laterally by the anterior scalene muscle [ Figure 4 ]; while the study of the subclavian artery (arterial TOS) is performed in the costoclavicular triangle which is the space formed anteriorly by the middle third of the clavicle, posteromedially by the first rib and posterolaterally by the upper profile of the scapula; in these patients, vascular compression is caused by the cervical rib and rarely by hypertrophic scalene muscles. [ 11 ] In our case, the discovery of flow congestion in the axillary vein occurred accidentally during a routine US follow-up of the axillary cavity which is performed with the arm raised and the return to normal flow with the lowering arm made us suspect the TOS. Subsequently, the comparative study with subclavian vessels and contralateral scalene muscles highlighted the right anterior scalene muscle hypertrophy, while CT excluded the presence of cervical ribs and other causes of vascular compression.…”

Section: Discussionmentioning

confidence: 87%

The role of ultrasound in venous thoracic outlet syndrome: Lesson based on a case report

et al. 2023

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Thoracic outlet syndrome is a rare neurovascular disease, usually caused by compression of subclavian vessels and/or brachial plexus by a cervical rib or hypertrophic scalene muscles. When the subclavian artery is compressed, it can cause perfusion deficiency with cyanosis and greater fatigue of the upper limb; if the subclavian vein is compressed, it can cause venous congestion with swelling and pain in the upper limb. When compression affects the brachial plexus, it can cause tingling or paresthesia of the upper limb. It can be mono or bilateral, congenital, or acquired. The diagnosis of vascular alterations is difficult due to the rarity, poor knowledge, and nonspecificity of symptoms. Ultrasound allows to localize and measure the vascular stenosis degree. Failure to diagnose can expose patients to serious health risks. We describe a rare case of venous compression caused by anterior scalene muscle hypertrophy.

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Section: Discussionmentioning

confidence: 87%

The role of ultrasound in venous thoracic outlet syndrome: Lesson based on a case report

et al. 2023

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“…Chronic poor posture may also result in shortening of the scalene and pectoral muscles and constrict the thoracic outlet [ 25 , 26 ]. Both nTOS and vTOS are occasionally reported in young athletes due to injury from repetitive overhead motions with hypertrophy and fibrosis of the anterior scalene and pectoralis minor muscles [ 22 , 27 ]. Other nontraumatic causes such as the presence of regional tumors and cysts may invade the thoracic outlet and compress the neurovasculature [ 28 ].…”

Section: Etiologymentioning

confidence: 99%

Thoracic Outlet Syndrome: A Narrative Review

Dierks

Vervaeke

et al. 2021

JCM

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Thoracic outlet syndrome comprises a group of disorders that result in compression of the brachial plexus and subclavian vessels exiting the thoracic outlet. Symptoms include pain, paresthesia, pallor, and weakness depending upon the compromised structures. While consensus in diagnostic criteria has not yet been established, a thorough patient history, physical exam, and appropriate imaging studies are helpful in diagnosis. General first-line therapy for thoracic outlet syndrome is a conservative treatment, and may include physical therapy, lifestyle modifications, NSAIDs, and injection therapy of botulinum toxin A or steroids. Patients who have failed conservative therapy are considered for surgical decompression. This article aims to review the epidemiology, etiology, relevant anatomy, clinical presentations, diagnosis, and management of thoracic outlet syndrome.

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“…The presence of some anatomical variants, such as cervical ribs, 1 st rib anomalies, hypertrophy of the cervical muscles in combination with repetitive motion, as well as fibrocartilaginous bands (1-3) may cause subclavian artery (SCA) entrapment and/or compression (2,(4)(5)(6)(7)(8). In addition, the atypical passage of the SCA through the anterior scalene muscle (ASM) or posterior to it (9,10) may cause compression on the SCA.…”

Section: Introductionmentioning

confidence: 99%

A Hypertrophic Anterior Scalene Muscle and the Passage of a Subclavian Artery Through its Fibres: The Location of Possible Entrapment

Tsakotos

Karampelias

Chatziandreou

et al. 2023

ama

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Objective. The presence of cervical ribs, 1st rib anomalies, cervical muscle hypertrophy and repetitive motion are possible aetiologies of subclavian artery (SCA) entrapment and/or compression. Thoracic outlet syndrome of the arterial type may appear with symptoms of hand pain due to the aneurismal part of the compressed SCA. The current cadaveric case describes a hypertrophic right-sided anterior scalene muscle (ASM) and the possible entrapment of the right SCA (RSCA) passing through its fibres. Furthermore, the branching pattern of the entrapped vessel is analysed.Case Report. A hypertrophic ASM was identified in the right infraclavicular area of a male Greek donated cadaver (70 years of age). The RSCA passed through the ASM belly, and some deeply situated fibres extended posteriorly to the RSCA. The ASM compressed the RSCA against the superior part of the 1st rib.Conclusion. Knowledge of such variants may be important in the diagnosis of upper limb muscle atrophy or neurosensory loss.

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Thoracic outlet syndrome: a rare case with bilateral cervical ribs and bilateral anterior scalene hypertrophy

Cited by 10 publications

References 18 publications

The role of ultrasound in venous thoracic outlet syndrome: Lesson based on a case report

The role of ultrasound in venous thoracic outlet syndrome: Lesson based on a case report

Thoracic Outlet Syndrome: A Narrative Review

A Hypertrophic Anterior Scalene Muscle and the Passage of a Subclavian Artery Through its Fibres: The Location of Possible Entrapment

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