Which anatomical site is a recognized site of compression in thoracic outlet syndrome?

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The main idea here is where thoracic outlet syndrome can compress neurovascular structures as they pass from the neck to the arm. A classic site is the interscalene triangle, the space between the anterior scalene (scalenus anticus) and middle scalene muscles as well as the first rib. This region is where the lower trunk of the brachial plexus and the subclavian artery traverse from the thorax into the arm, so tight scalene muscles, hypertrophy, or an anomalous rib can pinch these structures and produce the symptoms of TOS.

Carpal tunnel and ulnar tunnel are distal compression sites at the wrist, affecting the median nerve and ulnar nerve respectively, so they do not represent thoracic outlet compression. The suprascapular notch is another entrapment area, but it’s in the shoulder region and not part of the thoracic outlet pathway. Therefore, the scalenus anticus region—the interscalene triangle—is the recognized thoracic outlet compression site.