The first rib is the shortest, flattest, and most curved rib, articulating only with T1 (unlike ribs 2 through 9 which have two facets from adjacent vertebrae). Its superior surface has two grooves — the anterior subclavian vein groove and the posterior subclavian artery and brachial plexus groove — separated by the scalene tubercle where the anterior scalene inserts. The thoracic outlet is bounded by the first rib inferiorly.
Thoracic outlet syndrome is caused by structures compressing the subclavian vessels and brachial plexus as they cross the first rib — typically the anterior scalene, a cervical rib, or fibrous bands. First rib resection (transaxillary or supraclavicular) decompresses the thoracic outlet effectively. Congenital cervical ribs articulating with the first rib are present in 0.5 to 1 percent of people and produce thoracic outlet symptoms by further reducing the space.
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