Subluxation of the first rib: a possible thoracic outlet syndrome mechanism.

Twenty-two cases of both the thoracic outlet syndrome (TOS) and reflex sympathetic dystrophy (RSD) are described, four in detail. Each case had a hypomobile first rib on the painful side. A simple test was used to evaluate the first rib mobility. After isometric exercises of the scalene muscles, the mobility of the first rib was restored and the symptoms completely relieved in 13 patients. We concluded that the subluxation of the first rib may irritate the neural network and the stellate ganglion in the neighborhood of the first costotransverse joint. This in turn can cause the radiating pain and RSD symptoms.