cervical rib

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#CERVICAL_RIB:
Cervical rib is an accessory rib arising from the 7th cervical vertebra, rarely 6th and 5th cervical vertebra.
Incidence is 0.46 percent.
Nearly 50 percent of these are unilateral.
Side: It is more frequent on the right side.
Developmental Factors
• In the embryo nerves larger than the ribs interfere with the development of the costal process.
• When brachial plexus is Prefixed, well developed 4th cervical root and small 2nd Thoracic root offer little resistance to the costal process at the 7th cervical root.
• In post fixed brachial plexus, well-developed 1st thoracic Root offers, resistance to costal process of 7th cervical root. Obviously cervical rib is more common in the prefixed variety.
Types
Four varieties are described:
1. •Complete The cervical rib reaches up to the first thoracic Rib.
2. •Bulbous end In this the cervical rib has a bulbous end.
3. •Tapering end In this the cervical rib tapers.
4. •Fibrous band In this the rib is represented by a thick fibrous
Band.
Another classification
There are four types of cervical ribs:
Type 1: Complete rib that articulates with the first rib or manubrium
Type 2: Incomplete rib with a free distal tip
Type 3: Incomplete rib with a distal fibrous band attachment
Type 4: Short piece of bone extending beyond the C7 transverse process




Pathological Anatomy
• The neurovascular structures, the brachial plexus and Subclavian vessels are hung up by the cervical rib that is Inserted into the scalene tubercle of the 1st rib space.
• Pronounced drooping of the shoulder in women after Middle age, trauma, unusual lifting operations, acute illness
• Make the muscles weak, pulling the plexus and artery distally Giving rise to symptoms.
Associated Conditions
• 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.
Symptoms
1. Local Symptoms
Tender supraclavicular lump which is bony hard and is fixed when palpated.
2. 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.
3. Vascular symptoms
Cold and clumsy extremities, particularly the fingers.
Skin color changes to blue associated with trophic changes.
There is rare risk of gangrene.
Radial pulse becomes feeble or may even be absent.
4. Motor Symptoms
Loss of hand grip.
Tendency of dropping things from the hand.
Wasting of palmar muscles[9][10]






Management
1. Medical Management
Anti-inflammatory drugs
Analgesics
2. Surgical Management
In more severe cases,
Scalenotomy (resection of scalenus anterior muscle) may be Required and is successful in 70 percent of the cases.
In Troublesome cases removal of the cervical rib or the first rib Surgically with its periosteum to prevent its regeneration is Advocated.
Removalent.
Complete resection of the rib.
Dividing the scalene group of muscles.
Resection of cervical ribs for thoracic outlet syndrome.
Physiotherapy Management
On the basis of symptoms, the regime is planned.
• Pain relief: Thermotherapy For pain relief and relaxation., wave diathermy is used but it is contraindicated in case of sensory impairments.
• To improve distal circulation: Gripping exercise.
• Specific exercises like Self resisted scapular elevation and adduction.
• Self resisted strengthening exercises for shoulder elevation And adduction muscles.
• PRE with weight belts for shoulder Girdle muscles
• Exercises For the active arm especially the hand are Advised.
• Endurance training.
• Strengthening exercises of whole arm to improve tone, power and endurance.
• Posture Correction.
• Progressive resistance exercises for shoulder girdle muscles.