Cervical Rib: Difference between revisions

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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 flaoting with no connection<ref name=":0" />, fully formed bony rib or a thin strand of tissue fibre. They vary in size and shape.  
</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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* Loss of hand grip.
* Loss of hand grip.
* Tendency of dropping things from the hand.
* Tendency of dropping things from the hand.
* Wasting of palmar muscles<ref>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>
* 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 ==
== Diagnosis ==
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== Management  ==
== Management  ==


'''1. medical t'''
=== 1. Medical Management ===
* Anti-inflammatory drugs
* Analgesics


Anti-inflammatory drugs and
=== 2. Surgical Management ===
 
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.
* Removal of extra segment.
* Dividing the scalene group of muscles.
* 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).


=== 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  ==


Revision as of 09:07, 5 November 2020

This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work!(5/11/2020)

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]

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

  • Loss of hand grip.
  • Tendency of dropping things from the hand.
  • Wasting of palmar muscles[8][9]

Diagnosis[edit | edit source]

On imaging, cervical ribs can be distinguished because their transverse processes are directed inferolaterally, whereas those of the adjacent thoracic spine are directed anterolaterally.[10][11]

Cervical-ribs.jpg

Management[edit | edit source]

1. Medical Management[edit | edit source]

  • Anti-inflammatory drugs
  • Analgesics

2. Surgical Management[edit | edit source]

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

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.[8]

References[edit | edit source]

  1. ↑ Cervical Rib. Healthily. Available from https://www.livehealthily.com/neck-pain/cervical-rib [last accessed 05/11/2020]
  2. ↑ Cervical Rib. NHS. Available from https://www.nhs.uk/conditions/cervical-rib/ [ last accessed 05/11/2020]
  3. ↑ Fliegel BE, Menezes RG. Anatomy, Thorax, Cervical Rib.[updated 2020 Aug 22]. In:StatPearls[Internet].Treasure Island(FL): stat pearls publishing; 2020 jan.
  4. ↑ 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. ↑ 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 
  6. ↑ 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
  7. ↑ 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.
  8. ↑ 8.0 8.1 Physiotherapy treatment.com. Cervical Rib Syndrome. Available from https://www.physiotherapy-treatment.com/cervical-rib.html [last accessed 05/11/2020]
  9. ↑ Cervical Rib. Available from https://samarpanphysioclinic.com/2018/03/30/cervical-rib/ [last accessed 05/11/2020]
  10. ↑ Balan, Nisha Sharma, Anu (2008). Get through FRCR part 2B : rapid reporting of plain radiographs. London: Royal Society of Medicine. ISBN .
  11. ↑ Cervical Rib. Learning Radiology. Available fromhttps://learningradiology.com/notes/chestnotes/cervicalrib.htm [last accessed 05/11/2020]
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