WHAT IS SIBSON'S MUSCLE (&alenus pleratlis)?

By
Professor EDWARD FAWCETr, M.B. Edin., University College,
Bristol.
ACCORDING to Quain's Anatomy, p. 310, lines 18-23:-" The
scalenus pleuralis (Sibson) consists of fibres which arise from
the transverse process (? costal process) of the seventh cervical
vertebra, and spread out in the fascia supporting the cervical

FIG. 1.-View of apex of right pleural sac from outer side, and above ({).
P, dismembered scalenus anticus, or scalenus pleuralis, or both. SA, scalenus
anticus; SM, scalenus medius; SAr, subelavian artery; P, Sibson's fascia
covering apex of pleura ; R1, first rib; C0, anterior division of 8th cervical
nerve giving branch to P D1, anterior division of 1st dorsal nerve; LT, lower
trunk of brachial plexus.
dome of the pleura, by means of which they are inserted into
the inner border of the first rib."
According to Miacalister's Anatomy, p. 316, lines 23-26:-
"A few spreading muscular fascicles, segmented from the lowest
origin of the scalenus posticus, are attached to it (the fascia
covering the apex of the pleura)."
434 PROFESSOR EDWARD FAWCETT.

So far as I know, these are the only English text-books which

allude to the presence of this muscle, and it will be seen that
the allusion is but slight in both.
Having myself often observed this muscle, or at all events
something corresponding with it, I venture to describe what I
have observed in the last two subjects which have come under
my notice, because they have exhibited in a striking manner
structures and arrangements which indicate that this muscle is
perhaps not quite so simple as description at present would have
us believe.
In one subject the conditions were these:
On lifting up the scalenus anticus muscle and the third part
of the subclavian artery, a long-21 inches-muscular slip was
seen passing downwards between the subclavian artery and the
apex of the right pleural sac (?, fig. 1). This muscular slip,
when fully dissected out, was seen to arise from the costal
process of the seventh cervical vertebra, and to be inserted into
the inner border of the first rib by tendinous fibres near the
insertion of the scalenus anticus; but it was not wholly inserted
there; many muscular fibres from its inner side passed to the
fascia covering the apex of the right pleura, as shown in fig. 1.
Behind this muscle lay the anterior primary division of the
eighth cervical and first dorsal nerves, which separated it front
the scalenus medius muscle. According to the above descrip-
tions quoted, this muscle is the scalenus pleuralis of Sibson, but
it is a well known fact that a slip from the scalenus anticus
muscle sometimes passes behind the subelavian artery; and as
in this case the scalenus anticus muscle arose from the costal
process of the seventh cervical vertebra, the question naturally
arises: was this muscle the scalenus pleuralis of Sibson, or simply
this partially dismembered slip of the scalenus anticus ? It was
innervated by a branch of the eighth cervical nerve.
If this muscle were simply an anomalous slip of the scalenus
anticus, it at least sent fibres to the fascia of Sibson, and so far
corresponded with Sibson's muscle.
But the second case may throw some light on the nature of
this muscle.
This second example occurred in an old male subject on the
table at the same time as the one exhibiting the first, and in it,
 WHAT. IS SIBSON'S MUSCLE ? 435
on performing a similar dissection, a muscle was found which
resembled the first in that it lay behind the subclavian artery,
but it differed from it in having two heads of origin and two
slips of insertion (fig. 2,?).
One head of origin arose from the costal process of the seventh
cervical vertebra, the other arose from the neck of the first rib,
and these heads of origin were separated from one another by
the anterior primary division of the eighth cervical nerve videe

FiG. 2.-The right pleural sac seen from above and the outer side (@. ?, the
muscle composed of slips A and B. Is A the dismembered part of the
scalenus anticus, and is B the scalenus pleuralis ? SA, scalenus anticus; SM,
scalenus medius ; P, apex of right pleura covered by Sibson's fascia; S, sub-
clavian artery turned up; C8, anterior primary division of eighth cervical nerve;
D1, anterior primary division of first dorsal nerve ; LT, lower trunk of brachial
plexus; RI, first rib; Ba, anterior slip of insertion; (3, posterior ditto.
fig. 2). The head from the costal process of the seventh cervical
vertebra was blended with the lowest slip of origin of the
scalenus anticus muscle. Both heads united to form a belly,
which after a course of an inch or so again divided into two
slips of insertion. The inner slip (A, fig. 2) was inserted mainly
into the inner border of the first rib under cover of the scalenus
anticus, but some fibres from its inner side were inserted. into
Sibson's fascia. The outer slip (B, fig. 2) was inserted for the
greater part into Sibson's fascia, only a few tendinous fibres
436 WHAT IS SIBSON'S MUSCLE?
being prolonged to the first rib. We naturally ask ourselves
what is the nature of this muscle; for we have here a muscle
which, arising by two heads; one in conjunction with the lowest
slip of the scalenus anticus, the other from the neck of the first
rib, which is inserted by two slips, the inner of which runs
mainly to the first rib, but partly to Sibson's fascia, the other,
the outer, going mainly to Sibson's fascia, but partly to the first
rib. Can it be that the part arising from the costal process of
the seventh cervical vertebra in conjunction with the lowest
slip of the scalenus anticus is the dismembered part of the
scalenus antics which was behind thie subclavian artery and
therefore tallies somewhat with the muscle described as Case 1 ?
and is the other slip Sibson's muscle?
Whatever these muscles are, they appear to me to show that
the scalenus pleuralis of Sibson is not quite so simple as
text-books would have us believe; and it seems to be doubly
difficult to understand how it can be a dismembered part of
the scalenus posticus when it lies in front of the anterior
primary division of the eighth cervical and first dorsal nerves.
The only way in which it tallies with it is in its method of
origin from the costal process of the seventh cervical vertebra;
but as the scalenus anticus in both these cases arises also from
the same process, it seems to me to have as great a claim to the
scalenus pleuralis muscle as does the scalenus posticus.
On the opposite side, in Case 2, the muscle was small so far
as its belly was concerned, but there was a well-marked tendon
inserted chiefly into pleura fascia, partly into the first rib. Its
origin blended with the scalenus anticus.