First rib resection and corrective clavicle osteotomy using the infraclavicular approach for thoracic outlet syndrome due to clavicle malunion: A case report
Abstract Background Thoracic outlet syndrome can develop following the malunion of a clavicle midshaft fracture. To date, thoracic outlet syndrome complicated by clavicle malunion is typically treated with either first rib resection or corrective clavicle osteotomy; however, there have been no repor...
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BMC
2025-07-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | https://doi.org/10.1186/s12891-025-08855-x |
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| author | Ryogo Furuhata Atsushi Tanji Taku Suzuki Noboru Matsumura |
| author_facet | Ryogo Furuhata Atsushi Tanji Taku Suzuki Noboru Matsumura |
| author_sort | Ryogo Furuhata |
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| description | Abstract Background Thoracic outlet syndrome can develop following the malunion of a clavicle midshaft fracture. To date, thoracic outlet syndrome complicated by clavicle malunion is typically treated with either first rib resection or corrective clavicle osteotomy; however, there have been no reports of these two procedures being performed simultaneously using the same approach. We present the first documented case of thoracic outlet syndrome caused by clavicle malunion treated by simultaneous first rib resection and corrective clavicle osteotomy through a single infraclavicular approach. Case presentation A 46-year-old woman presented with numbness and muscle weakness in the left upper limb, which worsened with 90º abduction external rotation of the shoulder joint. She had a history of conservative treatment for a left clavicle midshaft fracture 21 years earlier. Magnetic resonance imaging taken with upper extremity elevation revealed stenosis of the left subclavian artery at the costoclavicular space. Three-dimensional clavicle symmetry plane demonstrated that the distal fragment of the left clavicle displaced inferiorly and malunited, and left scapular depressed and retracted. The distance between the left clavicle and the first rib was up to 7 mm shorter than that on the right side. She was diagnosed with left arterial thoracic outlet syndrome caused by clavicle malunion. Using an infraclavicular approach, we performed the first rib resection and clavicle osteotomy. We inserted the first rib bone graft into the osteotomy site and performed the plate fixation. Her symptoms had resolved by two years postoperatively. Conclusions The present case provides new information on the surgical procedure of thoracic outlet syndrome due to clavicle malunion. In our patient, the inferior displacement of malunited clavicle and the associated scapular malposition may cause narrowing of the costoclavicular space, resulting in the development of thoracic outlet syndrome. The present case demonstrates that the infraclavicular approach enables the simultaneous first rib resection and corrective clavicle osteotomy and provides reliable decompression of the costoclavicular space. Clinical trial number Not applicable. |
| format | Article |
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| institution | Kabale University |
| issn | 1471-2474 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
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| series | BMC Musculoskeletal Disorders |
| spelling | doaj-art-567a86915d004d6985f022e7ea9bf3d82025-08-20T03:33:38ZengBMCBMC Musculoskeletal Disorders1471-24742025-07-012611710.1186/s12891-025-08855-xFirst rib resection and corrective clavicle osteotomy using the infraclavicular approach for thoracic outlet syndrome due to clavicle malunion: A case reportRyogo Furuhata0Atsushi Tanji1Taku Suzuki2Noboru Matsumura3Department of Orthopaedic Surgery, Ashikaga Red Cross HospitalDepartment of Orthopaedic Surgery, Ashikaga Red Cross HospitalDepartment of Orthopaedic Surgery, Keio University School of MedicineDepartment of Orthopaedic Surgery, Keio University School of MedicineAbstract Background Thoracic outlet syndrome can develop following the malunion of a clavicle midshaft fracture. To date, thoracic outlet syndrome complicated by clavicle malunion is typically treated with either first rib resection or corrective clavicle osteotomy; however, there have been no reports of these two procedures being performed simultaneously using the same approach. We present the first documented case of thoracic outlet syndrome caused by clavicle malunion treated by simultaneous first rib resection and corrective clavicle osteotomy through a single infraclavicular approach. Case presentation A 46-year-old woman presented with numbness and muscle weakness in the left upper limb, which worsened with 90º abduction external rotation of the shoulder joint. She had a history of conservative treatment for a left clavicle midshaft fracture 21 years earlier. Magnetic resonance imaging taken with upper extremity elevation revealed stenosis of the left subclavian artery at the costoclavicular space. Three-dimensional clavicle symmetry plane demonstrated that the distal fragment of the left clavicle displaced inferiorly and malunited, and left scapular depressed and retracted. The distance between the left clavicle and the first rib was up to 7 mm shorter than that on the right side. She was diagnosed with left arterial thoracic outlet syndrome caused by clavicle malunion. Using an infraclavicular approach, we performed the first rib resection and clavicle osteotomy. We inserted the first rib bone graft into the osteotomy site and performed the plate fixation. Her symptoms had resolved by two years postoperatively. Conclusions The present case provides new information on the surgical procedure of thoracic outlet syndrome due to clavicle malunion. In our patient, the inferior displacement of malunited clavicle and the associated scapular malposition may cause narrowing of the costoclavicular space, resulting in the development of thoracic outlet syndrome. The present case demonstrates that the infraclavicular approach enables the simultaneous first rib resection and corrective clavicle osteotomy and provides reliable decompression of the costoclavicular space. Clinical trial number Not applicable.https://doi.org/10.1186/s12891-025-08855-xThoracic outlet syndromeClavicle malunionFirst rib resectionCorrective clavicle osteotomyBone graftInfraclavicular approach |
| spellingShingle | Ryogo Furuhata Atsushi Tanji Taku Suzuki Noboru Matsumura First rib resection and corrective clavicle osteotomy using the infraclavicular approach for thoracic outlet syndrome due to clavicle malunion: A case report BMC Musculoskeletal Disorders Thoracic outlet syndrome Clavicle malunion First rib resection Corrective clavicle osteotomy Bone graft Infraclavicular approach |
| title | First rib resection and corrective clavicle osteotomy using the infraclavicular approach for thoracic outlet syndrome due to clavicle malunion: A case report |
| title_full | First rib resection and corrective clavicle osteotomy using the infraclavicular approach for thoracic outlet syndrome due to clavicle malunion: A case report |
| title_fullStr | First rib resection and corrective clavicle osteotomy using the infraclavicular approach for thoracic outlet syndrome due to clavicle malunion: A case report |
| title_full_unstemmed | First rib resection and corrective clavicle osteotomy using the infraclavicular approach for thoracic outlet syndrome due to clavicle malunion: A case report |
| title_short | First rib resection and corrective clavicle osteotomy using the infraclavicular approach for thoracic outlet syndrome due to clavicle malunion: A case report |
| title_sort | first rib resection and corrective clavicle osteotomy using the infraclavicular approach for thoracic outlet syndrome due to clavicle malunion a case report |
| topic | Thoracic outlet syndrome Clavicle malunion First rib resection Corrective clavicle osteotomy Bone graft Infraclavicular approach |
| url | https://doi.org/10.1186/s12891-025-08855-x |
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