scholarly journals Exercise-induced Thoracic Outlet Syndrome and Concomitant Osteomyelitis in Cervical Rib with a Possible Familial Origin, a Case Report.

2021 ◽  
Author(s):  
Mohammadshah Isam Gul ◽  
Ammara Bint I Bilal ◽  
Fateen Ata ◽  
Renan E Ibrahem ◽  
Muhammad I Danjuma
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Left Shoulder ◽  
X Rays ◽  
Scalene Muscle ◽  
Case Presentation ◽  
Cervical Rib ◽  
Negative Culture ◽  
Exercise Induced ◽  
Intensive Physiotherapy ◽  
Cervical Ribs

Abstract BackgroundCervical ribs are a rare and usually asymptomatic occurrence. Most are identified incidentally by Roentgenogram (X-rays). However, occasionally they can cause nerve impingements and compressive symptoms. In cervical ribs, osteomyelitis secondary to trauma is unheard of. We report such a case made more interesting by the familial presence of bilateral cervical ribs in 2 generations. This indicates a possible familial origin. Case presentationA 26-year-old woman known to have fibromyalgia presented with left shoulder pain and fever episodes. She was recently discharged from intensive physiotherapy for fibromyalgia management, but the pain aggravated instead of getting better unilaterally in the left arm after discharge. Electric shock-like sensations and reduced strength accompanied this. An evaluation revealed leukocytosis and S. aureus positive blood and urine cultures along with bilateral complete cervical ribs showing pseudoarthrosis of anterior left cervical rib. A collection was noted in the left scalene muscle near the pseudoarthrosis accompanying focal edema suggesting osteomyelitis. Transthoracic echocardiogram (TTE) ruled out infective endocarditis. Thoracic surgery recommended conservative management, and appropriate antibiotics were given, which resulted in the negative culture on day 6. The patient was discharged on appropriate analgesia, and her pain was significantly improved on discharge.ConclusionsThis is the first reported case of osteomyelitis in the cervical rib. This report also highlights the possibility of cervical ribs having a familial origin. Additionally, as in our patient, certain exercises can be a risk factor for inducing TOS in patients with cervical rib.

scholarly journals Cervical Rib Surgery: A Study of 20 Cases

1970 ◽  
Vol 17 (1) ◽  
pp. 10-12 ◽  
Author(s):  
M Lutfor Rahman ◽  
G Mohammod ◽  
I Alam ◽  
MS Ali
Keyword(s):  
Upper Limb ◽  
Thoracic Outlet Syndrome ◽  
Small Study ◽  
Fibrous Band ◽  
Private Hospitals ◽  
Cervical Rib ◽  
Orthopedic Surgeon ◽  
Diagnosis And Management ◽  
Initial Surgery ◽  
Cervical Ribs

Cervical ribs give rise to vascular and neurogenic manifestation in the upper limb due to stretching and friction of neurovascular bundle in the base of the neck by numerous mechanisms that includes cervical ribs, anomalous ligament & hypertrophy of the scalenus anticus muscle. Controversy surrounds the diagnosis and management of thoracic outlet syndrome with or without cervical ribs. This is a small study of 20 cases carried out from 1994 to 2003 at RMCH, and some private hospitals. Out of them, 15 patients (75%) were male and 5 patients (25%) were female. The age of the patients was between 15 to 48 years (mean age 33 years) Unilateral cervical ribs were present in 75% cases and the rest 25% had bilateral cervical ribs. Only 3 patients presented with gangrenous upper limb. One of the patient attended to orthopedic surgeon first and amputation was planned. All the patient were treated through supra clavicular approach by excision of cervical ribs together with fibrous band. Only one patient did not respond to this initial surgery as symptoms persist and re-operation done by excision of first-rib and ultimately that patient become symptom free. In this study, authors explained their own experience of various way of presentation of cervical ribs, aetiology, different modalities of the treatment and their out come.     doi: 10.3329/taj.v17i1.3482 TAJ 2004; 17(1) : 10-12  

Undiagnosed bilateral complete cervical rib with subclavian artery aneurysm presenting as acute ischaemic limb following high-altitude expedition

2021 ◽  
Vol 14 (2) ◽  
pp. e241194
Author(s):  
Raja Lahiri ◽  
Udit Chauhan ◽  
Ajay Kumar ◽  
Nisanth Puliyath
Keyword(s):  
High Altitude ◽  
Subclavian Artery ◽  
Thoracic Outlet Syndrome ◽  
Artery Aneurysm ◽  
Limb Ischaemia ◽  
Cervical Rib ◽  
Subclavian Artery Aneurysm ◽  
Acute Limb Ischaemia ◽  
Arterial Thoracic Outlet Syndrome ◽  
Cervical Ribs

Arterial thoracic outlet syndrome is relatively rare and often exclusively seen in the presence of bony anomalies. High-altitude (HA) travel is commonly associated with thrombosis; however, arterial thromboembolism is less frequently described. We describe a case of a young man with undiagnosed bilateral cervical rib, who went for an HA trek, subsequent to which developed acute limb ischaemia of right arm. Diagnostic workup revealed a subclavian artery aneurysm as well along with complete bony bilateral cervical ribs. Thoracic outlet syndrome should be kept as a differential diagnosis in a case of acute limb ischaemia in a healthy adult.

scholarly journals Articulating Cervical Rib - A Culprit Often Overlooked on Imaging! : Review Article

2021 ◽  
Vol 11 (9) ◽  
pp. 230-236
Author(s):  
Pratik S. Itti ◽  
Sharad B. Ghatge ◽  
Shraddha Somani
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Tertiary Care ◽  
Case Series ◽  
Arterial Occlusion ◽  
Radiographic Examination ◽  
Main Body ◽  
Care Hospital ◽  
Cervical Rib ◽  
Arterial Complications ◽  
Cervical Ribs

Background: Cervical rib, though it is seen incidentally in the radiographic examination of chest and cervical spine, a particular subset of it can present with thoracic outlet syndrome. This article mainly focuses on the symptom causation of articulating cervical rib, as compared to non-articulating cervical rib which is often asymptomatic. There are many articles describing a cervical rib, but those highlighting this particular relation between the types of cervical rib and symptom causation are not present in present database. The review of serial radiographs upon correlating clinically, lead us to conclude that articulating variant of cervical rib is majorly symptomatic and caused grave arterial complications. The article consists brief discussions on the types of cervical ribs, thoracic outlet syndrome and role of imaging in diagnosing a cervical rib. Main Body: We have illustrated five such cases from our tertiary care hospital and highlighted the relationship between the magnitude of symptoms and variations of cervical rib. In compliance with PRISMA guidelines, we screened 33 articles dealing with cervical rib and 13 with thoracic outlet syndrome. Overall, 46 articles were filtered on studying the abstract. Further, 15 more had to be excluded as they were case reports and case series, and finally 31 articles were included in our study. We studied and discussed these articles and research papers in relation to variant anatomy of cervical rib, its types and symptom causation. In our study, also routine sequential chest radiographs were reviewed during the period of January 2020 to January 2021 and those with cervical rib and/or elongated C7 transverse process were included. Conclusion: Thus, to conclude we can state that articulating cervical ribs pose a greater threat and cause arterial occlusion. Key words: Cervical rib, thoracic outlet syndrome, subclavian artery.

scholarly journals A Never Described Variant of the Cervical Rib Causing Arterial Thoracic Outlet Syndrome: World's First Case

2021 ◽  
Vol 07 (03) ◽  
pp. e179-e183
Author(s):  
Saif Abdeali A. Kaderi ◽  
Pravin Shinde ◽  
Raviraj Tilloo ◽  
Sonewane Chetan ◽  
Tanvi Dalal ◽  
...  
Keyword(s):  
Oral Anticoagulation ◽  
Thoracic Outlet Syndrome ◽  
Transverse Process ◽  
Rest Pain ◽  
Postoperative Course ◽  
Cervical Rib ◽  
Artery Thrombosis ◽  
First Case ◽  
Arterial Thoracic Outlet Syndrome ◽  
Cervical Ribs

AbstractCervical ribs, also known as Eve's ribs, are rare and found in 1% of population. They are more common in females and more common on right side. They are asymptomatic in 90% of cases. Cervical rib fused with transverse process of sixth vertebra is rarer. We present a case of dry gangrene of lateral three fingers with right radial and subclavian artery thrombosis with rest pain, due to right cervical rib fused with transverse process of sixth vertebra. After development of line of demarcation of the dry gangrene, patient was operated for excision of cervical rib and sixth cervical vertebral transverse process followed by Ray's amputation of right second finger. Postoperative course was uneventful. Patient was discharged with oral anticoagulation and a healthy wound in right hand.

Histopathological basis for neurogenic thoracic outlet syndrome

2008 ◽  
Vol 8 (4) ◽  
pp. 347-351 ◽  
Author(s):  
R. Shane Tubbs ◽  
Robert G. Louis ◽  
Christopher T. Wartmann ◽  
Robert Lott ◽  
Gina D. Chua ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Thoracic Outlet Syndrome ◽  
Immunohistochemical Analysis ◽  
Histopathological Changes ◽  
Histological Findings ◽  
Histological Changes ◽  
Cervical Rib ◽  
Lower Trunk ◽  
Human Cadavers ◽  
Cervical Ribs

Object To the best of the authors' knowledge, no report exists that has demonstrated the histopathological changes of neural elements within the brachial plexus as a result of cervical rib compression. Methods Four hundred seventy-five consecutive human cadavers were evaluated for the presence of cervical ribs. From this cohort, 2 male specimens (0.42%) were identified that harbored cervical ribs. One of the cadavers was found to have bilateral cervical ribs and the other a single right cervical rib. Following gross observations of the brachial plexus and, specifically, the lower trunk and its relationship to these anomalous ribs, the lower trunks were submitted for immunohistochemical analysis. Specimens were compared with two age-matched controls that did not have cervical ribs. Results The compressed plexus trunks were largely unremarkable proximal to the areas of compression by cervical ribs, where they demonstrated epi- and perineurial fibrosis, vascular hyalinization, mucinous degeneration, and frequent intraneural collagenous nodules. These histological findings were not seen in the nerve specimens in control cadavers. The epineurium was thickened with intersecting fibrous bands, and the perineurium appeared fibrotic. Many of the blood vessels were hyalinized. The nerve fascicles contained frequent intraneural collagenous nodules in this area, and focal mucinous degeneration was identified. Conclusions Cervical ribs found incidentally may cause histological changes in the lower trunk of the brachial plexus. The clinician may wish to observe or perform further evaluation in such patients.

RELATO DE CASO: SÍNDROME DO DESFILADEIRO TORÁCICO

2018 ◽  
Vol 5 (3) ◽  
pp. 24-27
Author(s):  
Tatiane Silva Gonçalves ◽  
Raíssa Nunes Bezerra De Sá ◽  
Jéssica Neto Ferreira Pacheco ◽  
Alexis Alison Cardozo Leite ◽  
Pedro Manuel Gonzales Cuellar
Keyword(s):  
Brachial Plexus ◽  
Thoracic Outlet Syndrome ◽  
Vascular Complications ◽  
Contributing Factors ◽  
Scalene Muscle ◽  
Insidious Onset ◽  
Analgesic Medication ◽  
Bone Anomalies ◽  
Anterior Scalene Muscle ◽  
Cervical Ribs

RESUMO Introdução: A Síndrome do Desfiladeiro Torácico (SDT) é uma entidade clínica com sintomatologia diversa, decorrente de compressão anormal do plexo braquial, na região do desfiladeiro torácico. Esta compressão é exercida, na maioria das vezes, pelo músculo escaleno anterior, mas pode resultar também da existência de bandas musculofibróticas, alteração da morfologia da primeira costela, costelas cervicais e músculos anômalos. A SDT pode ser classificada nos tipos vascular e neurogênico. Descrição do caso: Paciente, sexo feminino, 27 anos, com quadro de dor e parestesia, há dois anos, de início insidioso, em 4º e 5º quirodáctilos e, posteriormente, com progressão para todo membro superior esquerdo (MSE). Procurou Unidade de Pronto Atendimento, sendo prescrito apenas medicação analgésica. Após três dias, apresentou intensificação da dor, associada a palidez e parestesia de MSE procurando atendimento no Hospital Geral de Palmas. Discussão: A SDT acomete mais mulheres entre 20-50 anos, com vários fatores contribuintes, chegando a limitar as atividades diárias e laborais. O tratamento clínico, frequentemente, é a conduta inicial, procurando aliviar os sintomas. Em geral, o tratamento cirúrgico tem indicação em 15 % dos casos, quando a síndrome é decorrente de anomalias ósseas sintomáticas e complicações vasculares.   Palavras-chave: Síndrome do Desfiladeiro Torácico; Costela Cervical; Plexo Braquial. ABSTRACT Introduction: Thoracic Outlet Syndrome (TOS) is a clinical entity with diverse symptomatology due to abnormal compression of brachial plexus in the thoracic outlet region. This compression is often carried out by the anterior scalene muscle, but it may be a result from the presence of musculofibrotic bands, alteration of the first rib morphology, cervical ribs and anomalous muscles. TOS can be classified into vascular and neurogenic types. Case description: Patient, female, 27 years old, with pain and paresthesia, since two years ago, insidious onset, in 4th and 5th fingers, and later with progression to all left upper limb (LUL). She looked for Emergency Care Unit, and only analgesic medication was prescribed. After three days, she presented pain intensification, associated with pallor and paresthesia of LUL, looking for care at the General Hospital of Palmas. Discussion: The TOS affects more women between 20-50 years old, with several contributing factors, limiting daily activities and work. The clinical treatment, often, is the initial conduct, seeking to relieve symptoms. In general, the surgical treatment is indicated in 15% of cases, when the syndrome is due to symptomatic bone anomalies and vascular complications. Keywords: Thoracic Outlet Syndrome; Cervical Rib; Brachial Plexus.

Crochet the Pain Away: A Case Study of Osteopathic Manipulation for Cervical Rib Induced Thoracic Outlet Syndrome

2021 ◽  
Vol 31 (2) ◽  
pp. 51-54
Author(s):  
Joshua A. Herring ◽  
Gabriela N. Soto ◽  
Sabrina Silver
Keyword(s):  
Physical Therapy ◽  
Thoracic Outlet Syndrome ◽  
Specific Treatment ◽  
Current Treatment ◽  
Activity Levels ◽  
Osteopathic Manipulation ◽  
Myofascial Release ◽  
Cervical Rib ◽  
The Right ◽  
Cervical Ribs

Abstract Background: Many people experience symptoms of thoracic outlet syndrome each year; one cause of these symptoms is the presence of cervical ribs. Cervical ribs have an estimated prevalence of 2% in the general population and 8.3% of those with thoracic outlet syndrome symptoms.1 Current treatment for thoracic outlet syndrome includes physical therapy and surgical resection. Techniques have been described for the treatment of thoracic outlet syndrome with osteopathic manipulation, but no specific treatment for cervical ribs was noted on a literature review. Case Presentation: 25-year-old healthy female presents with intermittent hand numbness and tingling along the C8 distribution that worsened with crocheting. She had also noted for many years the presence of a hard-supraclavicular mass on her left side. Palpation of this mass showed a bony protrusion that stopped 2 cm posterior to the clavicle on the left, but no mass noted on the right. Records review revealed an x-ray confirming cervical rib on the left. Results: After the treatment of surrounding dysfunctions without improvement in symptoms, the cervical rib was identified, manually isolated, and treated with direct myofascial release with respiratory assistance. This treatment provided immediate resolution of her symptoms. She remained asymptomatic for 10 days after treatment. A repeat treatment at two weeks resulted in resolution of her symptoms as far out as three months. Discussion: Cervical ribs are common in patients with thoracic outlet syndrome, and treatment for these patients typically includes physical therapy followed by surgical intervention for non-responders. We propose that OMT, with a focus on direct myofascial release, may be effective in alleviating symptoms for patients with cervical ribs. A limitation of this study is that it is a case report of one young active female. A larger study that includes various ages, activity levels, and both sexes would be more generalizable. Conclusion: Direct myofascial release is an effective technique for treatment of cervical rib induced thoracic outlet syndrome when myofascial restrictions are present.

Exercise-Induced Scalenus Syndrome

2008 ◽  
Vol 36 (2) ◽  
pp. 369-374 ◽  
Author(s):  
Panagiotis Baltopoulos ◽  
Charalampos Tsintzos ◽  
George Prionas ◽  
Maria Tsironi
Keyword(s):  
Quality Of Life ◽  
Thoracic Outlet Syndrome ◽  
Surgical Intervention ◽  
Case Series ◽  
Signs And Symptoms ◽  
Underlying Mechanism ◽  
Level Of Evidence ◽  
Full Activity ◽  
Exercise Induced

Background Thoracic outlet syndrome is described as a group of distinct disorders producing signs and symptoms attributed to compression of nerves and blood vessels in the thoracic outlet region. Purpose To describe the exercise-induced scalenus anticus syndrome attributed to the anterior scalenus hypertrophy as a thoracic outlet syndrome underlying mechanism and to give recommendations for a safe and effective surgical treatment. Study Design Case series; Level of evidence, 4. Methods Twelve young professional athletes admitted for thoracic outlet syndrome (8 cases of neurologic thoracic outlet syndrome, 4 cases of mixed neurologic and vascular thoracic outlet syndrome) who reported numbness, tingling, early fatigue, muscle weakness, and pain were enrolled in the study. Scalenus hypertrophy was suspected to be the causative factor. Scalenectomy was performed in all cases. Results All patients had moderate to severe hypertrophy of the anterior scalenus muscle. Scalenectomy was performed, and there were no intraoperative or postoperative complications. Full activity was quickly achieved, and no recurrence of symptoms was documented. Conclusion Surgical intervention for scalenus anticus syndrome can allow an athlete to return to full activity and improve quality of life. Surgical intervention seems to be the treatment of choice in terms of restoring quality of life and physical activity.

Anatomically Complete Supraclavicular Reoperation for Recurrent Neurogenic Thoracic Outlet Syndrome: Clinical Characteristics, Operative Findings, and Long-term Outcomes

Hand ◽  
2021 ◽  
pp. 155894472098807
Author(s):  
Momodou L. Jammeh ◽  
J. Westley Ohman ◽  
Chandu Vemuri ◽  
Ahmmad A. Abuirqeba ◽  
Robert W. Thompson
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Length Of Hospital Stay ◽  
Functional Improvement ◽  
Scalene Muscle ◽  
Neurogenic Thoracic Outlet Syndrome ◽  
First Rib ◽  
Previous Operation ◽  
Combined Operations ◽  
The Mean ◽  
Operative Findings

Background: The clinical outcomes of reoperations for recurrent neurogenic thoracic outlet syndrome (NTOS) remain undefined. Methods: From 2009 to 2019, 90 patients with recurrent NTOS underwent anatomically complete supraclavicular reoperation after previous operation(s) performed at other institutions using either supraclavicular (Prev-SC = 48), transaxillary (Prev-TA = 31), or multiple/combination (Prev-MC = 11) approaches. Prospectively maintained data were analyzed retrospectively. Results: The mean patient age was 39.9 ± 1.4 years, 72% were female, and the mean interval after previous operation was 4.1 ± 0.6 years. The mean Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score was 62 ± 2, reflecting substantial preoperative disability. Residual scalene muscle was present in 100% Prev-TA, 79% Prev-SC, and 55% Prev-MC ( P < .05). Retained/residual first rib was present in 90% Prev-TA, 75% Prev-SC, and 55% Prev-MC ( P < .05). There were no differences in operative time (overall 210 ± 5 minutes), length of hospital stay (4.7 ± 0.2 days), or 30-day readmissions (7%). During follow-up of 5.6 ± 0.3 years, the improvement in QuickDASH scores was 21 ± 2 (36% ± 3%) ( P < .01) and patient-rated outcomes were excellent in 10%, good in 36%, fair in 43%, and poor in 11%. Conclusions: Anatomically complete decompression for recurrent NTOS can be safely and effectively accomplished by supraclavicular reoperation, regardless of the type of previous operation. Residual scalene muscle and retained/residual first rib are more frequently encountered after transaxillary operations than after supraclavicular or multiple/combined operations. Supraclavicular reoperation can achieve significant symptom reduction and functional improvement for approximately 90% of patients with recurrent NTOS.

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