Occult Compression at the Pectoralis Minor-Second Rib Level After Cervical and First Rib Resection for Thoracic Outlet Syndrome: A Case Report.
Kosuke Okina, Taku Suzuki, Yasuhiro Kiyota et al.
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Case in brief
A 29-year-old woman with neurogenic thoracic outlet syndrome associated with a cervical rib continued to have symptoms after supraclavicular cervical and first rib resection. Postoperative imaging showed previously unrecognized compression at the pectoralis minor–second rib level, apparent after the initial decompression. She underwent infraclavicular pectoralis minor release and second rib resection. At 18 months after reoperation, her symptoms had nearly completely resolved, with no reported complications.
What made this case unusual
Compression at the pectoralis minor–second rib level became apparent after cervical and first rib decompression, providing an explanation for persistent symptoms.
Diagnostic / clinical pearl
When symptoms persist after cervical rib surgery for neurogenic thoracic outlet syndrome, reassess for brachial plexus compression at the pectoralis minor–second rib level.