CC BY 4.0 · J Brachial Plex Peripher Nerve Inj 2022; 17(01): e30-e32
DOI: 10.1055/s-0042-1753541
Case Report

Bilateral Thoracic Outlet Syndrome from Anomalous 8th Cervical Vertebrae Ribs

Scott Ferris
1   Department of Plastic, Hand and Faciomaxillary Surgery, Alfred Health, Melbourne, Victoria, Australia
1   Department of Plastic, Hand and Faciomaxillary Surgery, Alfred Health, Melbourne, Victoria, Australia
› Author Affiliations


Thoracic outlet syndrome (TOS) is a group of diverse disorders resulting from compression of neurovascular structures as they pass from the lower neck to upper limb. Neurological symptoms, such as pain, weakness, or paraesthesia, are much more common than vascular symptoms such as pallor or venous congestion. Anatomical abnormalities can contribute to this condition. Thirty percent of patients with TOS can have a cervical rib, arising from the transverse process of the 7th cervical vertebra, compared with 1% of the general population. We report the first case in the literature of neurogenic TOS from a cervical rib arising from a supernumerary 8th cervical vertebra. This patient had immediate improvement in TOS symptoms following scalene muscle surgery and resection of cervical and first thoracic ribs.

Publication History

Received: 01 June 2022

Accepted: 08 June 2022

Article published online:
18 July 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 Fugate MW, Rotellini-Coltvet L, Freischlag JA. Current management of thoracic outlet syndrome. Curr Treat Options Cardiovasc Med 2009; 11 (02) 176-183
  • 2 Li N, Dierks G, Vervaeke HE. et al. Thoracic outlet syndrome: a narrative review. J Clin Med 2021; 10 (05) 962
  • 3 Roos DB. Congenital anomalies associated with thoracic outlet syndrome. Anatomy, symptoms, diagnosis, and treatment. Am J Surg 1976; 132 (06) 771-778
  • 4 Brantigan CO, Roos DB. Diagnosing thoracic outlet syndrome. Hand Clin 2004; 20 (01) 27-36
  • 5 Chang KZ, Likes K, Davis K, Demos J, Freischlag JA. The significance of cervical ribs in thoracic outlet syndrome. J Vasc Surg 2013; 57 (03) 771-775
  • 6 Henry BM, Vikse J, Sanna B. et al. Cervical rib prevalence and its association with thoracic outlet syndrome: a meta-analysis of 141 studies with surgical considerations. World Neurosurg 2018; 110: e965-e978
  • 7 Galis F. Why do almost all mammals have seven cervical vertebrae? Developmental constraints, Hox genes, and cancer. J Exp Zool 1999; 285 (01) 19-26
  • 8 Klimo Jr P, Rao G, Brockmeyer D. Congenital anomalies of the cervical spine. Neurosurg Clin N Am 2007; 18 (03) 463-478
  • 9 Ankith NV, Avinash M, Srivijayanand KS, Shetty AP, Kanna RM, Rajasekaran S. Congenital osseous anomalies of the cervical spine: occurrence, morphological characteristics, embryological basis and clinical significance: a computed tomography based study. Asian Spine J 2019; 13 (04) 535-543
  • 10 Van AS, Bastiaan A. Polythelia and supernumerary cervical and thoracic vertebrae. South African J Child Health 2008; 2 (03) 130
  • 11 Sanders RJ, Hammond SL. Management of cervical ribs and anomalous first ribs causing neurogenic thoracic outlet syndrome. J Vasc Surg 2002; 36 (01) 51-56