What Is a Cervical Rib?

The cervical rib refers to the ribs on the seventh cervical spine, which is a congenital malformation. The literature reports that the incidence of cervical ribs is 0.6%. 55% of the cervical ribs were found by accident on X-ray examination and did not show clinical symptoms. The incidence is higher in women than in men. The occurrence of cervical ribs on both sides accounted for 50%. In unilateral cervical ribs, the incidence on the left and right sides is approximately equal.

Basic Information

Visiting department

orthopedics

Multiple groups

female

Common locations

7th cervical spine

Common causes

Congenital malformation

Common symptoms

Most cervical ribs have no clinical symptoms

Causes of cervical ribs

The cervical rib is attached to the cervical vertebra and the transverse process. It may be a simple exostosis or a more complete rib. The end of the small cervical ribs is free, or connected to the first sternum by a fiber band. The cervical ribs are divided into four types, type I: the cervical ribs are short and just past the transverse process; type II: the cervical ribs are more than the transverse process, the ends are free, or connected with the first sternum; type III: the cervical ribs are almost complete It is connected to the costal cartilage of the first sternum by a fiber band; Type IV: The cervical rib is intact and connected to the costal cartilage of the first sternum by the costal cartilage.

Clinical manifestations of cervical ribs

Most cervical ribs are asymptomatic. Symptomatic cervical ribs often cause thorax exit syndrome, which causes compression symptoms of the subclavian artery and brachial plexus, which can manifest neurological or vascular symptoms alone, or both.

Brachial plexus nerves are mostly located in the trunk through the gap of the oblique muscle, and often show mixed damage of the median nerve and ulnar nerve, so the pain and paresthesia of the upper limb and ulnar side of the hand are significant.

In addition, the sympathetic nerve may be compressed, causing vasomotor dysfunction, such as skin discoloration when the hand is drooping, gray-blue, sweating, edema, and disappear after lifting. When cold, fingers become pale. Cervical sympathetic paralysis syndrome sometimes occurs.

If the radial limb pulsation weakens or disappears in the affected limb, and the forearm and hand become swollen, compression of the subclavian artery should be considered. A positive Adson test is helpful for diagnosis.

Cervical rib examination

The cervical spine X-ray can determine the existence, size and type of cervical ribs.

Cervical rib diagnosis

Patients with thoracic outlet syndrome, especially female patients, who have the above clinical manifestations should suspect the disease and further X-ray examination.

Cervical rib treatment

Non-surgical treatment

Includes massage, physiotherapy, analgesics, exercise the strength of the obliques and scapularis muscles before exercise, raising the shoulders can relieve symptoms. Avoid carrying heavy objects, reduce excessive abduction of the affected upper limbs, and rest appropriately. Cervical traction is not effective for this condition.

2. Surgical treatment

If non-surgical treatment is not effective after 3 to 6 months, surgical treatment may be considered for severe symptoms.

(1) Indications Patients with persistent severe pain; Neurological or vascular signs in the upper limbs and hands are developing; Subclavian arteries are significantly compressed, causing transient attacks of pale and bruising fingers, or even embolism; Compression of the brachial plexus nerve with sensory disturbance or hand atrophy of the atrophic muscles.

(2) Surgical methods Cervical rib resection: suitable for type and cervical ribs that are relatively well developed, and the anterior scalene muscle and cervical ribs are usually cut through the clavicle; First rib resection: suitable for and Cervical ribs with fibrous bands cause neurovascular compression, usually through the axillary approach.