Cervical Rib: Difference between revisions
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'''Original Editor '''- [https://www.physio-pedia.com/User:Chelsea_Mclene Chelsea Mclene] | '''Original Editor '''- [https://www.physio-pedia.com/User:Chelsea_Mclene Chelsea Mclene] | ||
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== Introduction == | == Introduction == | ||
Cervical rib also known as "neck rib" or "supernumerary rib in cervical region" is an extra rib<ref>Cervical Rib. Healthily. Available from https://www.livehealthily.com/neck-pain/cervical-rib [last accessed 05/11/2020]</ref> that forms above [[First Rib|first rib]]<ref>Cervical Rib. NHS. Available from https://www.nhs.uk/conditions/cervical-rib/ [ last accessed 05/11/2020]</ref> which grows from the base of the neck just above the collarbone. It is a congenital overdevelopment of transverse process of cervical spine vertebra<ref>Fliegel BE, Menezes RG. [https://www.ncbi.nlm.nih.gov/books/NBK541001/#_NBK541001_pubdet_ Anatomy, Thorax, Cervical Rib].[updated 2020 Aug 22]. In:StatPearls[Internet].Treasure Island(FL): stat pearls publishing; 2020 jan. | '''Cervical rib''' also known as "'''neck rib'''" or "'''supernumerary rib in cervical region'''" is an extra rib<ref>Cervical Rib. Healthily. Available from https://www.livehealthily.com/neck-pain/cervical-rib [last accessed 05/11/2020]</ref> that forms above [[First Rib|first rib]]<ref>Cervical Rib. NHS. Available from https://www.nhs.uk/conditions/cervical-rib/ [ last accessed 05/11/2020]</ref> which grows from the base of the neck just above the collarbone. It is a congenital overdevelopment of transverse process of cervical spine vertebra<ref>Fliegel BE, Menezes RG. [https://www.ncbi.nlm.nih.gov/books/NBK541001/#_NBK541001_pubdet_ Anatomy, Thorax, Cervical Rib].[updated 2020 Aug 22]. In:StatPearls[Internet].Treasure Island(FL): stat pearls publishing; 2020 jan. | ||
</ref>. It can be on right, left or both sides and may be | </ref>. It can be on right, left or both sides and may be floating with no connection<ref name=":0" />, fully formed bony rib or a thin strand of tissue fibre. They vary in size and shape. | ||
In few cases, people having cervical rib may develop [[Thoracic Outlet Syndrome (TOS)|thoracic outlet syndrome]]<ref name=":0">Dr. Colin Tidy. Cervical Rib. Thoracic outlet syndrome. Patient. Available from https://patient.info/bones-joints-muscles/cervical-rib-thoracic-outlet-syndrome [last accessed 05/11/2020]]</ref> because of pressure on the nerves that may be caused by the presence of the rib. Partially formed extra rib may end in a swelling that shows as a lump in neck or it may tail off into a fibrous band of tissue that connects to the first proper rib<ref name=":1">Giles, Lynton G. F. (2009-01-01), Giles, Lynton G. F. (ed.), [http://www.sciencedirect.com/science/article/pii/B9780443067167000670 "Case 67 - Cervical ribs"], ''100 Challenging Spinal Pain Syndrome Cases (Second Edition)'', Edinburgh: Churchill Livingstone, pp. 311–314, doi:[https://doi.org/10.1016%2Fb978-0-443-06716-7.00067-0 10.1016/b978-0-443-06716-7.00067-0], ISBN </ref>. Most cases are not clinically relevant and do not have symptoms. They are generally discovered incidentally during x-rays and CT scans.<ref>Guttentag, Adam; Salwen, Julia (1999). "Keep Your Eyes on the Ribs: The Spectrum of Normal Variants and Diseases That Involve the Ribs". ''RadioGraphics''. '''19''' (5): 1125–1142. doi:[https://doi.org/10.1148%2Fradiographics.19.5.g99se011125 10.1148/radiographics.19.5.g99se011125]. PMID [https://pubmed.ncbi.nlm.nih.gov/10489169 10489169]</ref> | In few cases, people having cervical rib may develop [[Thoracic Outlet Syndrome (TOS)|thoracic outlet syndrome]]<ref name=":0">Dr. Colin Tidy. Cervical Rib. Thoracic outlet syndrome. Patient. Available from https://patient.info/bones-joints-muscles/cervical-rib-thoracic-outlet-syndrome [last accessed 05/11/2020]]</ref> because of pressure on the nerves that may be caused by the presence of the rib. Partially formed extra rib may end in a swelling that shows as a lump in neck or it may tail off into a fibrous band of tissue that connects to the first proper rib<ref name=":1">Giles, Lynton G. F. (2009-01-01), Giles, Lynton G. F. (ed.), [http://www.sciencedirect.com/science/article/pii/B9780443067167000670 "Case 67 - Cervical ribs"], ''100 Challenging Spinal Pain Syndrome Cases (Second Edition)'', Edinburgh: Churchill Livingstone, pp. 311–314, doi:[https://doi.org/10.1016%2Fb978-0-443-06716-7.00067-0 10.1016/b978-0-443-06716-7.00067-0], ISBN </ref>. Most cases are not clinically relevant and do not have symptoms. They are generally discovered incidentally during x-rays and CT scans.<ref>Guttentag, Adam; Salwen, Julia (1999). "Keep Your Eyes on the Ribs: The Spectrum of Normal Variants and Diseases That Involve the Ribs". ''RadioGraphics''. '''19''' (5): 1125–1142. doi:[https://doi.org/10.1148%2Fradiographics.19.5.g99se011125 10.1148/radiographics.19.5.g99se011125]. PMID [https://pubmed.ncbi.nlm.nih.gov/10489169 10489169]</ref> | ||
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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.<ref>Tani, Edneia M.; Skoog, Lambert (2008-01-01), Bibbo, Marluce; Wilbur, David (eds.), [http://www.sciencedirect.com/science/article/pii/B9781416042082100223 "CHAPTER 22 - Salivary Glands and Rare Head and Neck Lesions"], ''Comprehensive Cytopathology (Third Edition)'', Edinburgh: W.B. Saunders, pp. 607–632, ISBN. | 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.<ref>Tani, Edneia M.; Skoog, Lambert (2008-01-01), Bibbo, Marluce; Wilbur, David (eds.), [http://www.sciencedirect.com/science/article/pii/B9781416042082100223 "CHAPTER 22 - Salivary Glands and Rare Head and Neck Lesions"], ''Comprehensive Cytopathology (Third Edition)'', Edinburgh: W.B. Saunders, pp. 607–632, ISBN. | ||
</ref> | </ref> | ||
{{#ev:youtube| y_fpaqRg69M | 300}}<ref>Physio Vibes. Cervical Rib And Physiotherapy Management. Available from https://www.youtube.com/watch?v=y_fpaqRg69M [last accessed 05/11/2020]</ref> | |||
== Structure And Function == | |||
The cervical rib consists of a head, neck, and tubercle. It is attached posteriorly to the first rib by a fibrous band near in the insertion of the anterior scalene muscle. Cervical rib has no physiological function. | |||
There are four types of cervical ribs: | |||
* Type 1: Complete rib that articulates with the first rib or manubrium | |||
* Type 2: Incomplete rib with a free distal tip | |||
* Type 3: Incomplete rib with a distal fibrous band attachment | |||
* Type 4: Short piece of bone extending beyond the C7 transverse process | |||
== Associated Conditions == | == Associated Conditions == | ||
* [[Thoracic Outlet Syndrome (TOS)|Thoracic outlet syndrome]] due to compression of the lower trunk of the brachial plexus or subclavian artery. | * [[Thoracic Outlet Syndrome (TOS)|Thoracic outlet syndrome]] due to compression of the lower trunk of the brachial plexus or subclavian artery. | ||
* Compression of the [[brachial plexus]] may be identified by weakness of the muscles around the muscles in the hand. | * Compression of the [[Brachial Plexus|brachial plexus]] may be identified by weakness of the muscles around the muscles in the hand. | ||
* Compression of the subclavian artery is often diagnosed. | * Compression of the subclavian artery is often diagnosed. | ||
* Compression of the sympathetic chain may cause [[Horner's Syndrome|Horner's syndrome]].<ref name=":1" /> | * Compression of the sympathetic chain may cause [[Horner's Syndrome|Horner's syndrome]].<ref name=":1" /> | ||
== | == Symptoms == | ||
'''Local Symptoms''' | |||
* Tender supraclavicular lump which is bony hard and is fixed when palpated. | |||
'''Sensory Symptoms''' | |||
* Tingling in hands or fingers; confined either to radial side or ulnar side or sometimes involve even whole hand. | |||
* Pain which may radiate down the arm. | |||
'''Vascular symptoms''' | |||
* Cold and clumsy extremities, particularly the fingers. | |||
* Skin colour changes to blue associated with trophic changes. | |||
* There is rare risk of gangrene. | |||
* Radial pulse becomes feeble or may even be absent. | |||
'''Motor Symptoms''' | |||
* Loss of hand grip. | |||
* Tendency of dropping things from the hand. | |||
* Wasting of palmar muscles<ref name=":2">Physiotherapy treatment.com. Cervical Rib Syndrome. Available from https://www.physiotherapy-treatment.com/cervical-rib.html [last accessed 05/11/2020]</ref><ref>Cervical Rib. Available from https://samarpanphysioclinic.com/2018/03/30/cervical-rib/ [last accessed 05/11/2020]</ref> | |||
== Diagnosis == | |||
=== Imaging === | |||
Cervical ribs are a rare occurrence in the population with an incidence of under 1% and are often an incidental finding on radiographic imaging. they can be distinguished because their transverse processes are directed inferolaterally, whereas those of the adjacent thoracic spine are directed anterolaterally.<ref>Balan, Nisha Sharma, Anu (2008). ''Get through FRCR part 2B : rapid reporting of plain radiographs''. London: Royal Society of Medicine. ISBN .</ref><ref>Cervical Rib. Learning Radiology. Available from<nowiki/>https://learningradiology.com/notes/chestnotes/cervicalrib.htm [last accessed 05/11/2020] </ref>[[File:Cervical-ribs.jpg|thumb|200x200px]] | |||
{{#ev:youtube| cI4-kCNfLcs | 300}}<ref>Dr. Bradshawdc. Cervical Rib. Available from https://www.youtube.com/watch?v=cI4-kCNfLcs [last accessed 05/11/2020]</ref> | |||
=== Special Tests === | |||
* [[Adsons Test|Adson's test]] | |||
* [[Spurling's Test|Spurling's test]] | |||
* '''Shoulder Abduction test:''' It is an orthopaedic test used to diagnose a cervical nerve root injury or cervical disc herniation. It is performed by having the patient abduct their shoulder and place their hand on top of their head. A positive test will involve a decrease in radiculopathy or pain. | |||
== Differential Diagnosis == | |||
* [https://r.search.yahoo.com/_ylt=AwrxgvmcsKNf.yoANg3nHgx.;_ylu=Y29sbwMEcG9zAzEEdnRpZAMEc2VjA3Ny/RV=2/RE=1604591901/RO=10/RU=https%3a%2f%2fwww.physio-pedia.com%2fDisc_Herniation/RK=2/RS=qatuhE1B8tRvxUodzdKhq3XKCLM- Herniated] cervical disk | |||
* [https://physio-pedia.com/Cervical_Spondylosis?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal Cervical spondylosis] | |||
* [[Neuropathies|Peripheral neuropathies]] | |||
* Raynaud's disease | |||
* Syringomyelia | |||
* [[Poliomyelitis|Polio]] | |||
* Muscular dystrophy | |||
* Motor neuron disease | |||
== Management == | |||
=== 1. Medical Management === | |||
* Anti-inflammatory drugs | |||
* Analgesics | |||
=== 2. Surgical Management === | |||
* Removal of extra segment. | |||
* Complete resection of the rib. | |||
* Dividing the scalene group of muscles. | |||
* Resection of cervical ribs for thoracic outlet syndrome. | |||
=== 3. Physiotherapy Management === | |||
On the basis of symptoms, the regime is planned. | |||
* Pain relief: Short wave diathermy is used but it is contraindicated in case of sensory impairments. | |||
* To improve distal circulation: Gripping exercise. | |||
* Strengthening exercises of whole arm to improve tone, power and endurance. | |||
* Posture Correction. | |||
* Specific exercises like Self resisted scapular elevation and adduction. | |||
* Endurance training. | |||
* Progressive resistance exercises for shoulder girdle muscles.<ref name=":2" /> | |||
== References == | == References == | ||
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[[Category:Anatomy]] | [[Category:Anatomy]] | ||
[[Category:Spinal Cord - Anatomy]] | [[Category:Spinal Cord - Anatomy]] | ||
[[Category:Anatomy Project]] | [[Category:Anatomy Project]] | ||
[[Category:Cervical Spine]] | |||
[[Category:Cervical Spine - Conditions]] | |||
[[Category:Cervical Spine - Bones]] | |||
[[Category:Musculoskeletal/Orthopaedics]] | |||
[[Category:Genetic Disorders]] |
Latest revision as of 19:02, 8 March 2024
Original Editor - Chelsea Mclene
Top Contributors - Chelsea Mclene, Aminat Abolade and Kim Jackson
Introduction[edit | edit source]
Cervical rib also known as "neck rib" or "supernumerary rib in cervical region" is an extra rib[1] that forms above first rib[2] which grows from the base of the neck just above the collarbone. It is a congenital overdevelopment of transverse process of cervical spine vertebra[3]. It can be on right, left or both sides and may be floating with no connection[4], fully formed bony rib or a thin strand of tissue fibre. They vary in size and shape.
In few cases, people having cervical rib may develop thoracic outlet syndrome[4] because of pressure on the nerves that may be caused by the presence of the rib. Partially formed extra rib may end in a swelling that shows as a lump in neck or it may tail off into a fibrous band of tissue that connects to the first proper rib[5]. Most cases are not clinically relevant and do not have symptoms. They are generally discovered incidentally during x-rays and CT scans.[6]
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.[7]
Structure And Function[edit | edit source]
The cervical rib consists of a head, neck, and tubercle. It is attached posteriorly to the first rib by a fibrous band near in the insertion of the anterior scalene muscle. Cervical rib has no physiological function.
There are four types of cervical ribs:
- Type 1: Complete rib that articulates with the first rib or manubrium
- Type 2: Incomplete rib with a free distal tip
- Type 3: Incomplete rib with a distal fibrous band attachment
- Type 4: Short piece of bone extending beyond the C7 transverse process
Associated Conditions[edit | edit source]
- Thoracic outlet syndrome due to compression of the lower trunk of the brachial plexus or subclavian artery.
- Compression of the brachial plexus may be identified by weakness of the muscles around the muscles in the hand.
- Compression of the subclavian artery is often diagnosed.
- Compression of the sympathetic chain may cause Horner's syndrome.[5]
Symptoms[edit | edit source]
Local Symptoms
- Tender supraclavicular lump which is bony hard and is fixed when palpated.
Sensory Symptoms
- Tingling in hands or fingers; confined either to radial side or ulnar side or sometimes involve even whole hand.
- Pain which may radiate down the arm.
Vascular symptoms
- Cold and clumsy extremities, particularly the fingers.
- Skin colour changes to blue associated with trophic changes.
- There is rare risk of gangrene.
- Radial pulse becomes feeble or may even be absent.
Motor Symptoms
Diagnosis[edit | edit source]
Imaging[edit | edit source]
Cervical ribs are a rare occurrence in the population with an incidence of under 1% and are often an incidental finding on radiographic imaging. they can be distinguished because their transverse processes are directed inferolaterally, whereas those of the adjacent thoracic spine are directed anterolaterally.[11][12]
Special Tests[edit | edit source]
- Adson's test
- Spurling's test
- Shoulder Abduction test: It is an orthopaedic test used to diagnose a cervical nerve root injury or cervical disc herniation. It is performed by having the patient abduct their shoulder and place their hand on top of their head. A positive test will involve a decrease in radiculopathy or pain.
Differential Diagnosis[edit | edit source]
- Herniated cervical disk
- Cervical spondylosis
- Peripheral neuropathies
- Raynaud's disease
- Syringomyelia
- Polio
- Muscular dystrophy
- Motor neuron disease
Management[edit | edit source]
1. Medical Management[edit | edit source]
- Anti-inflammatory drugs
- Analgesics
2. Surgical Management[edit | edit source]
- Removal of extra segment.
- Complete resection of the rib.
- Dividing the scalene group of muscles.
- Resection of cervical ribs for thoracic outlet syndrome.
3. Physiotherapy Management[edit | edit source]
On the basis of symptoms, the regime is planned.
- Pain relief: Short wave diathermy is used but it is contraindicated in case of sensory impairments.
- To improve distal circulation: Gripping exercise.
- Strengthening exercises of whole arm to improve tone, power and endurance.
- Posture Correction.
- Specific exercises like Self resisted scapular elevation and adduction.
- Endurance training.
- Progressive resistance exercises for shoulder girdle muscles.[9]
References[edit | edit source]
- ↑ Cervical Rib. Healthily. Available from https://www.livehealthily.com/neck-pain/cervical-rib [last accessed 05/11/2020]
- ↑ Cervical Rib. NHS. Available from https://www.nhs.uk/conditions/cervical-rib/ [ last accessed 05/11/2020]
- ↑ Fliegel BE, Menezes RG. Anatomy, Thorax, Cervical Rib.[updated 2020 Aug 22]. In:StatPearls[Internet].Treasure Island(FL): stat pearls publishing; 2020 jan.
- ↑ 4.0 4.1 Dr. Colin Tidy. Cervical Rib. Thoracic outlet syndrome. Patient. Available from https://patient.info/bones-joints-muscles/cervical-rib-thoracic-outlet-syndrome [last accessed 05/11/2020]]
- ↑ 5.0 5.1 Giles, Lynton G. F. (2009-01-01), Giles, Lynton G. F. (ed.), "Case 67 - Cervical ribs", 100 Challenging Spinal Pain Syndrome Cases (Second Edition), Edinburgh: Churchill Livingstone, pp. 311–314, doi:10.1016/b978-0-443-06716-7.00067-0, ISBN
- ↑ Guttentag, Adam; Salwen, Julia (1999). "Keep Your Eyes on the Ribs: The Spectrum of Normal Variants and Diseases That Involve the Ribs". RadioGraphics. 19 (5): 1125–1142. doi:10.1148/radiographics.19.5.g99se011125. PMID 10489169
- ↑ Tani, Edneia M.; Skoog, Lambert (2008-01-01), Bibbo, Marluce; Wilbur, David (eds.), "CHAPTER 22 - Salivary Glands and Rare Head and Neck Lesions", Comprehensive Cytopathology (Third Edition), Edinburgh: W.B. Saunders, pp. 607–632, ISBN.
- ↑ Physio Vibes. Cervical Rib And Physiotherapy Management. Available from https://www.youtube.com/watch?v=y_fpaqRg69M [last accessed 05/11/2020]
- ↑ 9.0 9.1 Physiotherapy treatment.com. Cervical Rib Syndrome. Available from https://www.physiotherapy-treatment.com/cervical-rib.html [last accessed 05/11/2020]
- ↑ Cervical Rib. Available from https://samarpanphysioclinic.com/2018/03/30/cervical-rib/ [last accessed 05/11/2020]
- ↑ Balan, Nisha Sharma, Anu (2008). Get through FRCR part 2B : rapid reporting of plain radiographs. London: Royal Society of Medicine. ISBN .
- ↑ Cervical Rib. Learning Radiology. Available fromhttps://learningradiology.com/notes/chestnotes/cervicalrib.htm [last accessed 05/11/2020]
- ↑ Dr. Bradshawdc. Cervical Rib. Available from https://www.youtube.com/watch?v=cI4-kCNfLcs [last accessed 05/11/2020]