CERVICAL RIB

Cervical Rib  

                                                      

               

             Anterior view                                                                                         Lateral View       

                                                                        Posterior View

A cervical rib in humans is an extra rib which arises from the seventh cervical vertebra. Sometimes known as "neck ribs" their presence is a congenital abnormality located above the normal first rib. A cervical rib is estimated to occur in 0.2% (1 in 500 people) to 0.5% of the population. People may have a cervical rib on the right, left or both sides.It may be a fully-formed bony rib or just a thin strand of tissue fibres.

Signs & Symptoms

90% cases of cervical ribs are not clinically relevant and do not have symptoms; cervical ribs are generally discovered incidentally. and it produces symptoms after the age of 30 years.A patient may present with following symptoms:

 (a) Neurological Symptoms:

• Pain in your neck and shoulder, which spreads into your arm – this may be constant or come and go. This is commonly seen in thoracic outlet syndrome.
• Tingling and numbness,temporary loss of feeling in the affected arm and fingers(T1 dermatome). This is  the most common complaint.
• Wasting of the hand muscle and temporary inability in fine movement of hand like buttoning

 (b) Vascular Symptoms:

               

                subclavian artery compression

• An aneurysm in the subclavian artery which can affect the blood supply to the fingers leads to small red or black patches on the skin.

                                

                                  white colouration in hand

• There may be present of Raynaud's phenomenon – a condition that affects the blood supply to the fingers and toes, turning them white.
• Radial pulse becomes feeble or may even be absent.

(c) Local Symptoms:

• Sometimes, patient may present with the tenderness in supraclavicular lump which, on palpation very hard and fixed.
• Swelling in the affected arm but, this is very rare.

Diagnosis:

(1) Generally it is diagnosed by the X-Ray examination to detect cervical rib, which could be easily palpable.
it is attached to the seventh cervical vertebra.

                                                                                               Cervical Rib X-Ray

(2) Special test:

    (a)Adson's Test

                           

                              Adson's test

Indications- Evaluation of Cervical Ribs/ Thoracic Outlet Syndrome.
Technique- Patient breathes deeply, Neck extended, Chin turned toward affected side. The      examiner lifts the arm away to the side to 90 degrees and performs external rotation of the shoulder, and notes whether the radial pulse disappears. However there are many false positives, as the radial pulse may disappear in normal people as the head of the humerus (upper arm bone) compresses the brachial vessels when the arm is taken beyond 90 degrees. Repeat test with chin to opposite side.
Interpretation- Positive test finding suggests interscalene compression, decreased Radial Pulse and/or Distal extremity pain reproduced.

  (b) Foraminal Compression Test/ Spurling's Test

                            

                                  Spurling's test

Spurling's test is an orthopedic test used to diagnose nerve root compression primarily at the cervical level. It should not be used in instances in which vertebral instability is suspected.

   (c) Shoulder Abduction Test

                                 

                                   shouldr abduction test

Shoulder Abduction Test is an orthopedic test used to help 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:

Patient with cervical rib is to be differtiated from patients presents with radiatiang pain in upper limb and following are the causes:
1)Some of the more common conditions include herniated cervical disk, cervical spondylosis, and peripheral neuropathies.
2) Peripheral vascular disease like Raynaud's disease.
3) Neurological conditions-like syringomyelia, polio, muscular dystrophy, motor neuron disease.

Treatment

1. medical treatment:
Anti-inflammatory drugs and
analgesics
this two given as a coservative treatment.

2. surgical treatment:
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:

                                       

                                    Self resisted exercise

                              

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).