Arterial thoracic outlet syndrome (TOS) is a rare vascular abnormality. Its common cause is a cervical rib but it is seldom detected secondary to trauma of the clavicle, particularly in association with surgical repair of a fractured clavicle. An athletic 45-year-old man developed a recurrent ischaemic upper limb after repair to a non-union fractured clavicle. He underwent multiple separate procedures including embolectomy, angioplasty, thrombolysis and subclavian stent insertion. Definitive diagnosis was made using 3D reconstructed computer tomography. He had a subclavian artery stenosis with arm abduction as a result of loss of curvature of the clavicle after orthopaedic reconstructive surgery. The best surgical approach for this problem remains controversial.