Cervical Rib

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Original Editor - Chelsea Mclene

Top Contributors - Chelsea Mclene, Aminat Abolade and Kim Jackson  

Introduction

Cervical rib also known as "neck rib" or "supernumerary rib in cervical region" is an extra rib that forms above first rib which grows from the base of the neck just above the collarbone. It is a congenital overdevelopment of transverse process of cervical spine vertebra. It can be on right, left or both sides and may be flaoting with no connection, 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 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. Most cases are not clinically relevant and do not have symptoms. They are generally discovered incidentally during x-rays and CT scans.

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.

Associated Conditions

• 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.

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

Diagnosis

On imaging, cervical ribs can be distinguished because their transverse processes are directed inferolaterally, whereas those of the adjacent thoracic spine are directed anterolaterally.

Management

1. medical t

Anti-inflammatory drugs and

analgesics

this two given as a coservative treatment.

2. surgical t

surgery is essential in conditions of severe, progressive vascular and neurological signs and symptoms which are        unbearable for the patients. It includes:

• Removal of extra segment.
• Dividing the scalene group of muscles.

3. physiothrapy management:

On the basis of symptoms of the patient, the regime of physiotherapy is planned.

• For pain relief- short wave diathermy is used but it is contraindicated in case of sensory impairments.
• To improve distal circulation- gripping exercise like ball sqizing, spring stretching.
• To improve tone, power and endurance-Strengthening exercises of whole arm perticularly small muscles of the arm.
• For posture Correction -In this, patient is guided to use mirror to see that his shoulders are in level, head is straight, looking forward
• Specific exercises- To develop particular muscles groups for specific movements of shoulder girdle like elevation, retraction, and raising the arm overhead as these movements brings spontaneous relief. The important exercises are:

1-Self resisted scapular elevation.

2-Self resisted scapular adduction.

3-Endurance training exercise for the shoulder girdle muscles.

4-Progressive resistance exercises for shoulder girdle muscles with weight.

• Deep Tissue Massage for TOS ( thoracic Outlet Syndrome).