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Pediatr Neurosurg. 2007;43(4):293-6.

Cervical rib fracture: an unusual etiology of thoracic outlet syndrome in a child.

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Department of Neurosurgery, Hospital Santa Marcelina, São Paulo, Brazil.


Thoracic outlet syndrome in children is an extremely rare disorder. Only 5 previous reports were presented in the literature with a description of thoracic outlet syndrome in 8 children. In these cases, the diagnosis of a cervical rib was common. We describe a case of neurogenic thoracic outlet syndrome in a 9-year-old patient where the initial symptoms occurred 2 months after a fall. Clinically, the patient developed progressive pain, numbness and tingling along the inner surface of the left forearm and in the palmar surface of the fourth finger and lateral aspect of the fifth finger. A plain radiography showed a cervical rib fracture and an electrophysiologic study suggested the presence of left lower brachial plexus neuropathy. Her fractured cervical rib was resected through a supraclavicular approach. Her symptoms resolved completely in the postoperative period. Although very rare one should keep in mind the possibility of thoracic outlet syndrome in children, especially with a history of trauma over the shoulder girdle presenting with a cervical rib and a lower brachial plexopathy.

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