• Plummer B

• Adult
• Male
• Open Access Document
• Ribs
• Thoracic Outlet Syndrome

Objective: To describe an unusual presentation of thoracic outlet syndrome (TOS) due to a residual rib following a prior first rib resection as well as the role of chiropractic care in evaluation and co-management.

Clinical Features: A 30-year-old male with a history of bilateral first rib resections had progressive neck pain and neurogenic symptoms in his left upper extremity. Symptoms included numbness, tingling, and shooting pain, aggravated by upright posture and alleviated by slouching. The examination revealed postural asymmetry, reduced cervical range of motion, and positive orthopedic tests for TOS.

Intervention and Outcome: Chiropractic treatment included gentle low-force spinal manipulation and McKenzie cervical retraction exercises, which temporarily improved cervical spine pain. However, persistent symptoms prompted referral to a vascular surgeon. Diagnostic imaging revealed a residual first rib segment on the left side, necessitating a revision first rib resection. Post-surgical follow-up indicated complete resolution of radicular symptoms and significant improvement in cervical mobility.

Conclusion: This case highlights the role of chiropractic assessment in identifying structural contributors to TOS and facilitating timely surgical referral. A collaborative approach between chiropractic and medical specialties is essential in managing complex neurogenic TOS cases.

Author keywords: Thoracic Outlet Syndrome; Chiropractic; Rib

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