Iatrogenic compression of the thoracic outlet.

Arterial injury and brachial plexus nerve compression have been reported in association with surgical procedures in the area of the thoracic outlet. An initial report of iatrogenic injury was related to the operative correction of Sprengel's deformity, which required lowering of the scapula in a child. Compression of the neurovascular bundle between the clavicle and the first rib occurred during this surgical migration. The developmental anatomy of the costo-clavicular area and the descent of the upper limb from its initial cervical position are reviewed. This relationship between the clavicle and the first rib may also be altered by surgical procedures carried out on adults. Two cases of the iatrogenic injury to the brachial plexus are reported in association with operations performed in the area of the clavicle. Correction of these injuries resulted when the costoclavicular space was re-established.