The pathogenesis is uncertain. Some authorities attribute the changes to compression of the subclavian vessels and, sometimes, the lower or medial trunks of the brachial plexus against a cervical rib, an abnormal 1st thoracic rib, or a putatively abnormal insertion or position of the scalene muscles. The true neurovascular condition can be suspected by the distribution of symptoms. Also helpful is the auscultation of bruits at the clavicle or the apex of the axilla, or the finding of a cervical rib by x-ray. Some patients will show kinking or partial obstruction of axillary arteries or veins on angiography, but these are not incontrovertible evidence of disease.
Most patients respond to physical therapy and exercises.
Except when obvious cervical ribs or subclavian artery obstructions can be identified, operation is best avoided or the decision left to the experienced specialist. Go to the top You may schedule a confidential appointment in my office to explain any topics or treatment options discussed on this page.