This document discusses cervical rib syndrome, which is caused by an extra rib arising from the 7th cervical vertebra (cervical rib). A cervical rib can compress the lower trunk of the brachial plexus or subclavian artery, causing nerve and vascular symptoms like neck, shoulder, and arm pain. Physical tests like Adson's maneuver and Allen test aim to diagnose cervical rib syndrome by checking for reduced pulse with arm positioning. Treatment begins conservatively with postural advice and stretches, but surgery to remove the cervical rib may be needed if symptoms do not improve. Complications of cervical rib surgery include injury to nearby nerves and blood vessels.
This document discusses cervical rib syndrome, which is caused by an extra rib arising from the 7th cervical vertebra (cervical rib). A cervical rib can compress the lower trunk of the brachial plexus or subclavian artery, causing nerve and vascular symptoms like neck, shoulder, and arm pain. Physical tests like Adson's maneuver and Allen test aim to diagnose cervical rib syndrome by checking for reduced pulse with arm positioning. Treatment begins conservatively with postural advice and stretches, but surgery to remove the cervical rib may be needed if symptoms do not improve. Complications of cervical rib surgery include injury to nearby nerves and blood vessels.
This document discusses cervical rib syndrome, which is caused by an extra rib arising from the 7th cervical vertebra (cervical rib). A cervical rib can compress the lower trunk of the brachial plexus or subclavian artery, causing nerve and vascular symptoms like neck, shoulder, and arm pain. Physical tests like Adson's maneuver and Allen test aim to diagnose cervical rib syndrome by checking for reduced pulse with arm positioning. Treatment begins conservatively with postural advice and stretches, but surgery to remove the cervical rib may be needed if symptoms do not improve. Complications of cervical rib surgery include injury to nearby nerves and blood vessels.
• A cervical rib is a supernumerary (or extra) rib which arises from the 7th cervical vertebra. • Sometimes known as "neck ribs", • It is a congenital abnormality located above the normal first rib. • A cervical rib is estimated to occur in 0.2% to 0.5% of the population. • May be present on one or both side (Rt/Lt) Patho-anatomy • A cervical rib represents a persistent ossification or delayed ossification of the C7 lateral costal element. • During early development, this ossified costal element re-absorbed. • Failure of this process results in a variably elongated transverse process or complete rib that can be anteriorly fused with the first rib below. • The presence of a cervical rib can cause a form of TOS due to compression of the lower trunk of the brachial plexus or subclavian artery. • Cervical rib syndrome is one of the types of TOS. History
• 1740 Hunauld: first reported
• 1860 Willshire, 1869 Gruber: conception for diagnosis • 1861 Coote: first surgical removal of cervical rib Clinical Features • Nerve compression: – Traction & compression: C8, T1 nerve root (lower trunk) – Pain in neck & shoulder, arm & it is reproducible on suitable postural position – Radiating pain, paresthesia & numbness: median & ulnar nerve dermatome – Sustained traction on the shoulder by pulling the pts wrist may reproduce the symptoms. – Passive elevation of the shoulder girdle may relieve symptoms. • Arterial compression: – Pain, claudication, pallor, Raynaud phenomenon • Venous compression: – Coolness, venous dilation, edema – Subclavian vein thromboembolism, peripheral necrosis Diagnosis
• Physical Tests: Adson test, Allen test, Roos test
Wright’s test etc. • Myelogram • X-ray, CT, MRI • Angiogram, Doppler test • EMG/NCV Adson’s Maneuver • Patient is sitting or standing • Examiner externally rotates and extends the patient's arm while palpating the radial pulse • Patient then extends and rotates the neck towards the test arm and takes a deep breath • Positive Test: Diminished or absent radial pulse Implicating Thoracic outlet syndrome or compression of the subclavian artery by the scalene muscles Allen Test • Patient in sitting or standing with shoulder in 90° of abduction and external rotation, and the elbow in 90° of flexion • Patient rotates the neck away from the test arm • Examiner palpates the radial pulse • Positive Test • Diminished or absent radial pulse indicates TOS. Roos Test • sitting or standing with both shoulders in 90° of abduction and external rotation, and the elbows in 90° of flexion • Patient rapidly opens and closes both hands for 3 minutes. • Positive Test • Inability to maintain the test position, Diminished motor and sensory function in the upper extremities indicates Thoracic outlet syndrome, neurovascular compromise Wright’s Test (Hyper-abduction Maneuver) • Patient is seated with arms at the side . • The radial pulse is palpated • Step one: Places the patient’s shoulder into abduction and external rotation to 90 °. The elbow is flexed around 45° . Ask the patient to take a deep breath and hold. This position is held for 1 minute. • Step two: Repeat the previous test with the patient’s arm in hyper abduction (end range of abduction). • Test the contra lateral side. • Positive test: change in radial pulse and/or symptom reproduction. This position compresses the neurovascular bundle as it travels under the pectoralis minor muscle. • It has greatest sensitivity for neurogenic and vascular TOS (Hooper et. al., 2010, Watson et. al, 2009) Management • Aims To restore pain free movts Correct postural deviation • Methods: Advice for Postural correction Strengthening ex for shoulder girdle msl Stretching of Scalene muscle & pectoral muscle over prolonged period of time Cervical Traction –controversial Cervical Collar may be used to avoid jerks/jolts. If fails – removal of cervical ribs by surgery Surgical Mgt • If no improvement with conservative T/t. • Complications of Surgery: – Brachial plexus injury – Subclavian vessels injury – Phrenic nerve injury – Perforation of pleura – Bleeding & hematoma – Infection Thank you