BILATERAL RUDIMENTARY FIRST RIBS AS A CAUSE OF THORACIC OUTLET SYNDROME

First rib abnormalities are an uncommon cause of thoracic outlet syndr ome. Cervical ribs are a much more frequent source of thoracic outlet syndrome, and in more than 95% of these patients, the symptoms are neu rologic, not vascular. Rudimentary First ribs, however, uncommonly pro duce exclusively neurologic symptoms and usually manifest with vascula r pathology. This article reviews a case of a patient with bilateral e xtensively neurologic thoracic outlet syndrome symptoms arising from b ilateral rudimentary first ribs. The symptoms, pathologic features, an d treatment, as well as an algorithm for working up patients with thor acic outlet syndrome, are discussed. Bilateral transaxillary first rib resection was curative in this patient and is the treatment of choice for either neurologic or vascular manifestations of thoracic outlet s yndrome associated with rudimentary first ribs.