Abstract
A 34-year-old man spontaneously presented with bilateral thoracic outlet syndrome over 1 year. He was a gymnast active in rowing and weightlifting, with "slanted" shoulders, narrowed costoclavicular spaces, and well-developed scalene muscles. Imaging revealed fractures of multiple bilateral upper ribs in various degrees of nonunion. The patient's symptoms improved after activity modification and physiotherapy. Atraumatic spontaneous rib fracture-nonunions are an uncommon cause of thoracic outlet syndrome; this diagnosis should be considered in physically active patients presenting with typical symptoms with atypical anatomy.
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