Scalenus anticus syndrome

Controversial. More commonly diagnosed in the 1940s and 1950s. There is a lack of consensus regarding the pathophysiology (including structures involved), clinical presentation, helpful tests, and optimal treatment. Removal of the first thoracic rib is frequently advocated for treatment via a transaxillary approach. Unfortunately, injuries, especially to the lower trunk of the brachial plexus, may result from the surgery. Other variations include an “upper plexus” type for which total anterior scalenectomy is advocated. Again, very controversial.