Changes may be due to compression of the subclavian vessels and sometimes of 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 distribution of symptoms suggests the syndrome. Symptoms of pain and paresthesias are most often distributed medially in the arms and sometimes extend into the adjacent anterior chest wall. Auscultating bruits at the clavicle or apex of the axilla or finding a cervical rib by x-ray helps. Kinking or partial obstruction of axillary arteries or veins may be seen with angiography, but neither is incontrovertible evidence of disease.
Most patients respond to physical therapy and exercises.
If cervical ribs or subclavian artery obstructions are identified, an experienced specialist should decide if surgery is necessary. All rights reserved.