The first rib is the shortest, broadest and most curved of all ribs, with a flat superior surface crossed by grooves for the subclavian vessels and marked by the scalene tubercle. Its head carries a single facet for T1 only, and its angle coincides with the tubercle. The first rib forms the floor of the thoracic outlet, over which the subclavian vessels and brachial plexus pass.
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| Ossification | Endochondral ossification from a primary centre in the body, with secondary centres for the head and tubercle appearing around puberty and fusing by about age 25. |
The first rib is rarely fractured because of its protected position beneath the clavicle. When fractured by high-energy trauma, the injury implies significant force and should prompt a search for brachial plexus, subclavian vessel and cervical spine injury. Thoracic outlet syndrome arises when the brachial plexus or subclavian vessels are compressed as they cross the first rib, by the anterior scalene, fibrous bands or a cervical rib. Cervical ribs from C7 are present in roughly 0.5 to 1 percent of people. First rib resection (transaxillary or supraclavicular) decompresses the outlet in refractory cases.
Fracture of the well-protected first rib implies high-energy trauma and should prompt a search for subclavian vessel and brachial plexus injury; stress fractures also occur in throwing athletes.
Narrowing of the space between the first rib, clavicle, and scalene muscles compresses the brachial plexus or subclavian vessels; first rib resection is sometimes required.
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