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Thoracic Outlet Syndrome in a Patient With Absent Scalenus Anterior Muscle

Collins, Robert M. MBBCh, MSc*; Bhana, Jasvanti BSc, MBBCh*,†; Patricios, Jonathan S. MBBCh, MMedSci*; Du Plessis, Andre MBChB, MMed; Veller, Martin MBBCh, MMed§; Schultz, Donovan BTech, MScMed, MMedSci, PhD; Janse van Rensburg, Dina C. MD, MMed, MSc, MBChB*

Clinical Journal of Sport Medicine: May 2014 - Volume 24 - Issue 3 - p 268–270
doi: 10.1097/JSM.0000000000000006
Case Report

Abstract: This case report describes the rare anomaly of an absent right anterior scalene muscle presenting with the symptoms and signs of the thoracic outlet syndrome. The thoracic outlet syndrome in our patient can be attributed to the absence of the right anterior scalene muscle, which resulted in the brachial plexus being in proximity to the subclavian vein and artery in a narrowed and abnormal interscalene space. In addition, the absence of the anterior scalene muscle resulted in the neurovascular structures being compressed onto the first rib in the costoclavicular space. The most likely cause of the presentation is, however, the possibility of the presence of aberrant muscle slips, which would cause compression of the structures in the anterior (venous) and posterior (neurological) sections of the thoracic outlet.

*Section Sports Medicine, University of Pretoria, Pretoria, South Africa;

AstraZeneca Pharmaceuticals, Johannesburg, South Africa;

Netcare Union Hospital, Johannesburg, South Africa; and

§Department of Surgery, University of Witwatersrand, Johannesburg, South Africa.

Corresponding Author: Robert M. Collins, MBBCh, MSc, Section Sports Medicine, University of Pretoria, PO Box 3264, Houghton, Johannesburg 2014, South Africa (

The authors report no conflicts of interest.

Received February 05, 2013

Accepted July 30, 2013

© 2014 by Lippincott Williams & Wilkins