The anterior scalene inserts via a narrow tendinous slip onto the scalene tubercle on the inner border of the first rib, anterior to the subclavian artery groove. This insertion point is the primary compressive element in thoracic outlet syndrome, where the tendon narrows the costoclavicular space.
The anterior scalene tendon is the key surgical target in anterior thoracic outlet syndrome. Scalenectomy or anterior scalene tendon release decompresses the brachial plexus and subclavian vessels in neurogenic and vascular TOS. Botulinum toxin injection into the anterior scalene can confirm the diagnosis and provide temporary relief before surgical planning.
Fibrosis and tightening of the anterior scalene insertion contributing to thoracic outlet syndrome, with arm paresthesias and vascular symptoms provoked by arm elevation.
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