This Publication Is Searchable The Merck Manual of Diagnosis and Therapy Section 14. Neurologic Disorders Chapter 183. A group of ill-defined syndromes characterized by symptoms of pain and paresthesias in the hand, neck, shoulder, or arms. Syndromes include the neurovascular compression syndromes of the shoulder girdle, scalenus anticus syndrome, and cervical rib syndrome. They are more common in women, usually between ages 35 and 55.
Pathogenesis is unknown.
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.