Vascular pectoralis minor syndrome as an overlooked condition: A case report

Thoracic outlet syndrome is characterized by pain, paresthesia, muscle weakness, and arterial/venous symptoms caused by compression of the neurovascular structures. Compression mainly occurs at three distinct areas in the thoracic outlet: the retropectoralis minor space, the costoclavicular space, and the interscalene triangle. As the symptoms of these three compression sites are very similar, it is difficult to pinpoint the location of the compression and the treatment methods are quite different. Ultrasound-guided diagnostic injections play an important role in the differential diagnosis. Herein, we report a 49-year-old female patient who was previously diagnosed with thoracic outlet syndrome and scheduled for decompression of cervical ribs, but cured by conservative methods after being diagnosed with pectoralis minor syndrome.

Cervical ribs and their surgical treatment. H. Jacobsohn (Arch, f. Klin. Chirurg. Bd. 161. H. 3)

H. Jacobsohn (Arch, f. Klin. Chirurg. Bd. 161. H. 3), based on the proposals of the Americans Adson and Coffey (1926), in 8 cases. the cervical ribs cut the tendon w. scalenus, anter.

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

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.

Evaluatation Of Rib Variations In Chest Radiograph

Rib variations are usually incidental findings on imaging studies and are rarely symptomatic. If in adequately evaluated they are easily overlooked as most of the X-ray is aimed at evaluating the lung parenchyma. Trauma related lesions might usually be misinterpreted as rib variations and sometimes rib lesions may mimic a variant of rib and radiologists should be familiar with a number of normal variants of the ribs to avoid mistaking them for an abnormality. In this article we will discuss and illustrate variety of anatomical rib variants and their incidence in this given population. Anatomical rib variants include developmental deformities, cervical rib, Bifid (forked), fused rib and hypertrophied transverse process of C7 be used. The aim of our study is to have a comprehensive evidence-based morphological assessment of normal anatomical variations of ribs and their prevalence in this population. A Retrospective study of Chest radiographs of 1000 adults who visited our hospital for a routine check-up or for various medical examinations from September 1st 2018 to September 30th 2018, were consecutively reviewed for normal variations of rib. In our study of 1000 radiographs (Male 652 and female 348), there are 10 cervical ribs, 5 bifid ribs, 16 cases of hypertrophied transverse process and 3 fused rib. Thus in conclusion, the knowledge of incidence of normal anatomical variations of ribs and their appearance in a given population is important for radiologist as it avoids any misinterpretation of these relatively normal variants and signals a possibility of neurovascular compression if clinically relevant.

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

Cervical 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.

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

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

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.

Staged surgical treatment of brachioplexopathy in an adolescent with Klippel-Feil syndrome: a rare clinical case and literature review

Klippel-Feil syndrome is a congenital malformation, the leading component of which is a violation of segmentation of the cervical vertebral bodies. The syndrome can be combined with other skeletal anomalies: skull asymmetry, scoliosis, high shoulder blades, and cervical ribs. Treatment of the syndrome is usually symptomatic; indications for surgical treatment are progressive neurological disorders and persistent pain syndrome, which usually develop due to instability of unblocked segments, or neurogenic pain. A clinical case of treatment of a 17-year-old patient with Klippel-Feil syndrome who developed a picture of severe upper limb monoparesis during three years due to compression of the brachial plexus associated with cervical ribs is presented. Decompression of the brachial plexus was performed, which led to rapid relief of pain syndrome and gradual partial regression of motor disorders. Due to incomplete restoration of the gripping function, tendon-muscle plasty of the right hand was performed, which significantly improved the possibility of self-care. The results of radiation and staged neurophysiological studies are described, as well as a review of the literature on the Klippel-Feil syndrome.