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The Journal of Bone and Joint Surgery (American) 84:437-440 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Case Report

Thoracic Outlet Syndrome Treated by Double Osteotomy of a Clavicular Malunion

A Case Report

John F. Connolly, MD and Mehrdad Ganjianpour, MD

Investigation performed at Orlando Regional Medical Center, Orlando, Florida

John F. Connolly, MD
1314 Kuhl Avenue, Orlando, FL 32806

Mehrdad Ganjianpour, MD
Tower Orthopaedics, 8631 West 3rd Street, Suite 940E, Los Angeles, CA 90048

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.


   Introduction
 
Although most clavicular fractures in adults heal with no or minimal persistent symptoms, the rate of symptomatic malunion or nonunion of displaced fractures of the clavicle has ranged from 3% to 5% in a number of reports1-5. In a previous study of fifteen clavicular nonunions and malunions2, the senior one of us (J.F.C.) found that seven patients experienced intermittent or chronic symptoms associated with impingement on the thoracic outlet. These symptoms occurred most often when the patient abducted the shoulder or elevated the arm to an overhead position. Such patients are sometimes treated for cervical disc disease or, as in this case report, managed with resection of the first rib without relief of symptoms.

We and others3,5-7 have observed that the diagnosis and the surgical correction of thoracic outlet syndrome secondary to clavicular malunion may be delayed. Because clavicular fractures usually heal without sequelae, patients who present with . . . [Full Text of this Article]


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