A 19-year-old man was seen with pain and paresthesia in his right upper limb especially during overhead activities. He described that his complaints ensued for the last 5–6 weeks. Although he denied any history of major trauma, the patient admitted that he had overused his right upper extremity in the interim. Additionally, he narrated that he had noticed a thread-like structure in his right axilla recently. The medical history was otherwise noncontributory. A thorough neuromusculoskeletal examination of the neck and the upper extremities were unremarkable. The aforementioned complaints of the patient could be elicited during provocative maneuvers for TOS (Roos and hyperabduction tests) on the right side. On palpation, a very thin (but tight) band-like structure was detected, extending between the pectoralis and biceps muscles traversing quite superficially through the axilla. Moreover, during palpation, the patient also suffered pain and paresthesia in his right arm and palm. Cervical X-rays and static/dynamic Doppler imaging were all normal. Eventually, the patient was diagnosed to have disputed neurogenic TOS. Since we considered that the band could easily be excised by a simple approach without need for a major TOS surgery, we referred the patient to Thoracic Surgery Department. Although, the patient refused surgery initially; as his complaints persisted on the 3rd week control visit, he accepted to be operated thereafter. When the patient was seen one day before surgery (as he was planned to be hospitalized), he interestingly declared that the band had probably been ruptured during a strenuous movement at the weekend. Since the band could not be palpated on the repeat physical examination and as the complaints of the patient no more existed, he was called for a control visit with reassurance. Our message in this report is simple and clear; during evaluation for TOS, each and every patient should be examined also with respect to the axillary area. This should be done in patients with and even without relevant signs and symptoms described in that region. Because, unless visible or palpable, the patient may not necessarily be aware of an aberrant structure. Herein, a practical suggestion would be to start this evaluation during Roos test; quite similar to observing for any color change of the upper limbs (i.e. for arterial or venous compromise). In cases with thicker bands, sonographic confirmation would be reasonable and quite convenient as well [1]. In our patient, we were unable to demonstrate the thin band with sonography, and it was thought to be delineated during surgery. However, as the treatment plan was substantially changed after the rupture of the band, we could not classify it into a previously reported category [2, 3] or as a new entity. Finally, although our patient’s thin band was ruptured unintentionally, controversy surrounds the question whether such bands can be manipulated before surgery. L. Ozcakar A. B. Carli O. Durmus M. Z. Kiralp Department of Physical Medicine and Rehabilitation, Gulhane Military Medical Academy Haydarpasa Training Hospital, Istanbul, Turkey