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Cervical Rib

A cervical rib is an extra rib arising from the seventh cervical vertebra that can cause thoracic outlet syndrome by compressing the brachial plexus or subclavian artery. There are four varieties ranging from a complete rib articulating with the manubrium or first rib to a fibrous band incorporated into muscles. Symptoms include pain, numbness, and coldness in the arm as well as weakness that are worsened by certain maneuvers. Imaging such as x-rays can diagnose an elongated C7 transverse process or abnormal first rib. Treatment options include medications, exercises, injections, and surgery to resect the first rib.

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159 views15 pages

Cervical Rib

A cervical rib is an extra rib arising from the seventh cervical vertebra that can cause thoracic outlet syndrome by compressing the brachial plexus or subclavian artery. There are four varieties ranging from a complete rib articulating with the manubrium or first rib to a fibrous band incorporated into muscles. Symptoms include pain, numbness, and coldness in the arm as well as weakness that are worsened by certain maneuvers. Imaging such as x-rays can diagnose an elongated C7 transverse process or abnormal first rib. Treatment options include medications, exercises, injections, and surgery to resect the first rib.

Uploaded by

Yashaswi A
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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CERVICAL RIB

INTRODUCTION
• Extra rib which arises from the seventh cervical vertebra

• congenital

• abnormality located above the normal first rib

• cervical rib on the right, left or both sides

• female:male at 7:3
• The presence of a cervical rib can cause a form of thoracic outlet
syndrome due to compression of the lower trunk of the brachial
plexus or subclavian artery.

• These structures become encroached upon by the cervical rib and


scalene muscles
4 Varieties of Cervical rib

• Complete rib which articulates with manubrium sterni or first rib

• Almost Complete rib:Free end expands into bony mass.This variety give rise
to visible swelling

• True Incomplete rib:Ends into fibrous band which is connected to scalene


tubercle of the first rib

• only Fibrous band:Closely applied or incorporated into scalene medius


muscle.This anamolymay not be revealed in x-ray
Pathology
• A cervical rib represents a persistent ossification of the C7 lateral
costal element. During early development, this ossified costal
element typically becomes re-absorbed. Failure of this process results
in a variably elongated transverse process or complete rib that can be
anteriorly fused with the T1 first rib below

• Vascular symptoms are caused by constriction of lumen of subclavian


artery as the artery is lifted by cervical rib
CLINICAL FEATURES

Local symptoms

• Lump in the lower part of neck.

• Tenderness in supraclavicular fossa

• Lump is bony hard in consistency and fixed


Vascular symptoms:

• Pain -radiates from neck to upper arm and forearm

• Numbness

• Affected upper limb is often cold,pale

• Raynaudsphenomenon can be observed

• Systolic bruit may be noted


Neurologic symptoms:
• Pain and tingling sensation in the arm and forearm

• Wasting of hypothenar eminence

• Hypoaesthesia or anaesthesia supplied by T1 segment

• Weakness of the muscles of hand


Adson maneuver
• Patient is instructed to take and hold a deep breath and extend his
neck fully and then asked to turn his head towards the side being
examined. Obliteration or diminition in the radial pulse suggest
compression
DIFFERENTIAL DIAGNOSIS

• Raynauds disease

• MND

• Polio

• Muscular dystrophy
IMAGING
• X-rays C spine
• Elongated C7 transverse process
• Hypoplastic 1st rib
• Callous formation from clavicle or 1st rib fracture
• Pseudoarthrosis of 1st rib
Treatment
• Muscle relaxants
• NSAIDS
• Excercise
• Transcutaneous electric nerve stimulation (TENS)
• Local anesthetic injections.
• Surgery
Surgery
1st rib resection
1. Transaxillary approach (Roos approach)
2. Supraclavicular approach
3. Infraclavicular approach
4. Posterior approach.
Thank You

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