Transaxillary Approach for First Rib Resection in Combined Neurogenic and Vascular Thoracic Outlet Syndrome with Elongated C7 Transverse Process and Status Post Breast Implantation: A Case Report

Abstract

She complained of the inability to put on make-up properly as an initial symptom. She was evaluated by an orthopedist who attempted to perform steroid injection at her wrist without clinical improvement. Upon physical examination, it revealed severe atrophy of right thenar and hypothenar muscle as well as weakness of intrinsic muscle of hand (Figure 1). It also showed numbness of right hand and distal forearm. Her radial pulse became absent upon neck extension and Abstract Combined neurogenic and arterial Thoracic Outlet Syndrome (nTOS and aTOS) is a rare disease. First rib resection with scalenectomy is a mainstay of treatment. TOS results from pathology in the interscalene triangle. Many etiologies were described as its contributing factors, however, to the author’s knowledge, axillary breast implantation had not yet been described. In patients who have mild anatomical pathology, scar formation from axillary surgery may aggravate TOS symptoms. The author wishes to present a case of mild elongated C7 transverse process that then underwent breast implantation, subsequently developed combined nTOS and aTOS, successfully managed through transaxillay first rib resection and scalenectomy.