Definition
(Cervical rib): A cervical rib in humans is a supernumerary (or 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 present in
only about 1 in 500 (0.2%) of people; in even rarer cases, an individual may
have two cervical ribs.
Causes:
- Cervical
rib is generally seen only on one side of the body, more often on the
right.
- It
may be a complete or partial rib.
- This
condition is present in approximately 0.5 percent of the population.
- It
is caused by a congenital defect during bone formation.
Symptoms and signs: Cervical rib is
usually asymptomatic and is detected when a chest or neck X-ray is taken for
some other purpose.
In other cases the condition produces symptoms in
middle age due to sagging of shoulders and decline of muscle tone.
Symptoms are seen in women more often than in men.
The symptoms occur due to the rib pressing on the nerves or blood vessels, as
they go from the spinal column to the arm.
Sensory symptoms like pain and tingling numbness
are complained of in the forearm and hand, especially the inner side
corresponding to the little finger.
Motor symptoms include weakness of the arm and hand
and impaired fine movements like writing and sewing.
Vascular symptoms – If the blood
vessels like the subclavian artery are compressed, there may be bluish
discolouration of the skin of that limb due to diminished blood supply or in
rare cases frank gangrene of the fingers and the pulse at the wrist may be weak
or absent.
Diagnosis: The diagnosis
may be incidental during a routine check up or if the patient complains of
these symptoms the doctor may suspect the condition and order an X-ray of the
neck. The diagnosis may be confused with carpal tunnel syndrome, cervical disc
prolapsed and neuritis of the ulnar nerve supplying part of the forearm and
hand.
Investigations: Apart from an
X-ray, arteriography is required if vascular symptoms are seen. In this
procedure, dye is injected to outline the blood vessels in that region and then
films are taken.
Treatment:
Physiotherapy: In mild cases,
shrugging exercises of the shoulder are advised to tone the shoulder muscles
and the toned muscles keep the cervical rib from compressing the vital
structures. The patient is advised against lifting heavy objects like
suitcases, grocery bags etc.
In moderate to severe cases, surgery is the only
treatment option. The rib can be removed surgically after which there is no
recurrence of the problem.
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