Cervical Rib Surgery: A Study of 20 Cases

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

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

BMJ Case Reports ◽

10.1136/bcr-2020-241194 ◽

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.

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

International Journal of Health Sciences and Research ◽

10.52403/ijhsr.20210935 ◽

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.

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Cervical rib - a clinical case report

National Journal of Clinical Anatomy ◽

10.1055/s-0039-3401764 ◽

2014 ◽

Vol 03 (04) ◽

pp. 240-243

Author(s):

V Lokanayaki

Keyword(s):

Case Report ◽

Upper Limb ◽

Thoracic Outlet Syndrome ◽

Clinical Case ◽

Arterial Occlusion ◽

Cervical Vertebra ◽

Imaging Procedures ◽

Surgical Department ◽

Cervical Rib ◽

Seventh Cervical Vertebra

AbstractThe cervical rib is surgically important than being just anatomical curiosity alone. The distal parts of costal processes in seventh cervical vertebra occasionally develop as cervical rib. A 32 years old female patient who attended the vascular surgical department presented with features of cervical rib on the left side. Imaging procedures confirmed bilateral cervical rib for which the patient underwent surgery. The cervical rib can cause thoracic outlet syndrome with features of acute arterial occlusion in upper limb. This case is reported to stress the important complications due to the cervical rib.

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

The Surgery Journal ◽

10.1055/s-0041-1731654 ◽

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.

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Histopathological basis for neurogenic thoracic outlet syndrome

Journal of Neurosurgery Spine ◽

10.3171/spi/2008/8/4/347 ◽

2008 ◽

Vol 8 (4) ◽

pp. 347-351 ◽

Cited By ~ 18

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.

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Digital ischaemia of the upper limbs in middle age: consider arterial thoracic outlet syndrome until proven otherwise !

Rheumatology Advances in Practice ◽

10.1093/rap/rkaa045 ◽

2020 ◽

Author(s):

Wissam Al-Jundi ◽

Woo Sup Michael Park

Keyword(s):

Upper Limb ◽

Thoracic Outlet Syndrome ◽

Delayed Diagnosis ◽

Digital Ulcers ◽

Limb Ischaemia ◽

Middle Aged ◽

Aged Patients ◽

Cervical Rib ◽

Digital Ischaemia ◽

Arterial Thoracic Outlet Syndrome

Abstract Objectives Patients presenting with digital upper limb ischaemia are occasionally referred to rheumatology services to rule out vasculitis. We present two cases of delayed diagnosis of arterial thoracic outlet syndrome (TOS) in middle aged patients presenting with digital ischaemia in order to raise awareness of this important pathology that requires timely surgical intervention. Methods Two cases of progressive ischemia of the right upper extremity caused by primarily undiagnosed compression of the subclavian artery (SCA) by an accessory cervical rib are presented. Both patients case notes, radiological images, intra-operative and postoperative findings were reviewed. Patients were followed up after at least 6 months to assess prognosis. Results Both patients had working diagnosis of Buerger’s disease and treated with prostaglandin infusions prior to establishment of the diagnosis of arterial thoracic outlet syndrome. Both patients were heavy smokers and one patient had bilateral symptoms and history of axial spondyloarthropathy and positive HLA-B27. Surgical thrombectomy of the upper limb arteries along with resection of a cervical rib and repair of the SCA with interposition graft were necessitated to successfully heal digital ulcers in one patient. However, late presentation in the second patient led to the loss of three fingers and the need of plastic reconstructive surgery following cervical rib resection and revascularisation. Conclusion High index of suspicion of arterial TOS should be maintained in middle aged patients presenting with digital or upper limb ischaemia even in presence bilateral symptoms or relevant risk factors of other diagnoses such as smoking or positive rheumatological history.

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Cervical Rib causing Thrombosis of Subclavian Atery

Journal of Nepal Medical Association ◽

10.31729/jnma.138 ◽

2010 ◽

Vol 49 (178) ◽

Cited By ~ 1

Author(s):

P Sharma ◽

I Rasheed ◽

MA Ansari ◽

GS Gurung ◽

SP Chataut

Keyword(s):

Subclavian Artery ◽

Upper Limb ◽

Unusual Case ◽

Left Subclavian Artery ◽

Color Doppler ◽

Doppler Studies ◽

Complete Occlusion ◽

X Ray ◽

Cervical Rib ◽

Cervical Ribs

We describe here an unusual case of thrombosis of left subclavian artery in a patient with cervical rib. The patient presented with features of ischaemia of left upper limb. X-ray chest revealed bilateral cervical ribs, longer on the left side. Color Doppler studies showed echogenic thrombus within the left subclavian artery. Angiography revealed complete occlusion of left subclavian artery. Embolectomy was done. She was planned for excision of rib. KEYWORDS: cervical rib, thrombosis of subclavian artery.

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

10.21203/rs.3.rs-403083/v1 ◽

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.

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

The AAO Journal ◽

10.53702/2375-5717-31.2.51 ◽

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.

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THORACIC OUTLET SYNDROME

The Professional Medical Journal ◽

10.29309/tpmj/2018.25.03.367 ◽

2018 ◽

Vol 25 (03) ◽

pp. 350-354

Author(s):

Khadija Iqbal ◽

Aisha Asim ◽

Ibad-ur- Rehman ◽

Samra Asif

Keyword(s):

Clinical Examination ◽

Nerve Conduction ◽

Thoracic Outlet Syndrome ◽

Patient Management ◽

Surgical Excision ◽

Cervical Rib ◽

Diagnosis And Management ◽

Second Category ◽

Treatment And Diagnosis

Introduction: Thoracic outlet syndrome represents a variety of symptoms rangingfrom neurogenic to vascular. The thoracic outlet syndrome considered as a disputed disorderand management and diagnosis need special attention. Objective: The present study wasdone with the objective was to observe association of thoracic outlet syndrome with cervical riband the treatment and diagnosis options given to the patients once they present in the OPD.Study Design: Observational. Sampling: Convenience. Duration: January 2015-2017 January.Materials and methods: In this study the cervical rib was present in 3 males out of 58 cases.In females 8 had cervical rib out of 150 cases. Results: Out of eleven patients only six wereadvised surgical excision to relieve symptoms of thoracic outlet syndrome. Analgesics were alsoprescribed to all patients. The second category who did not have cervical rib nerve conductionstudies were advised to only 12 males and 10 females. In our study patients presenting withnumbness or and any vascular complaint only 11 cases had cervical rib. The treatment advisedfor relieving symptoms was surgical in only six patients and analgesics in all cases. Thetreatment for patients without cervical rib was analgesics and nerve conduction was advisedonly in 22 patients. Conclusion: The diagnosis and management of TOS is a combination ofneurophysiological testing and clinical examination outcomes. The use of advanced techniquescan lead to better patient management in our hospitals.

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