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Thoracic outlet syndrome (TOS) comprises of either neurogenic, arterial or venous compression which can occur at several sites in the thoracic outlet, of which arterial TOS is the rarest form. Anatomical causes include presence of cervical ribs, untreated clavicular fractures, clavicular pseudoarthrosis and first rib pseudoarthrosis. We present the case of a patient with bilateral clavicular and first rib pseudoarthrosis who presented with arterial TOS, with no anatomical causal relationship between the clavicular pseudoarthrosis and the TOS, but rather with the first rib pseudoarthrosis resulting in an abnormal rib curvature which was thought to be contributory to the TOS. [ABSTRACT FROM AUTHOR]