Congenital anomaly where-by an extra cervical rib or posteriorly fixed brachial plexus results in ↑ angulation of the subclavian artery & first thoracic nerve over the first rib
Aetiology
Epidemiology
Cervical ribs occur in 0.4% of the population (70% are bilateral)
Only symptomatic in 10% of cases
Anatomy
Pathology
Classification
History
Examination
Investigations
X-Rays
An occasional well formed rib is seen
yet these are less likely to cause significant symptoms
Elongation of the lateral mass of C7
likely presence of a fibrous band
this sharp fibrous band is more likely to result in symptoms
EMG
not as good as clinical examination in establishing the diagnosis
Differential Diagnosis
Carpal tunnel syndrome
but the sensory & motor changes are not confined to the distribution of the median nerve
Ulnar tunnel syndrome
again the changes are not confined to the distribution of the ulna nerve
Pancoast syndrome
(apical carcinoma of the bronchus) may infiltrate the structures at the root of the neck causing pain numbness & weakness of the hand
Clinically, large lump in the neck & chest X-Ray typical features of malignancy
Cervical spine lesions
eg disc prolapse or spondylosis where neck movements are limited
TB & mets- X-Rays usually differentiate the cause
Spinal cord lesions
such as syringomyelia
may cause wasting of the hand but other neurological features suggest diagnosis (dissociated pain & temperature loss)
Cuff lesions
have painful shoulder & arm movements
Treatment
Nonoperative
exercises to improve support of shoulder girdle associated with weight reduction are usually adequate
Operative
excision of the rib or fibrous band
indicated if the above fails in the presence of severe symptoms
significant neurological or vascular disturbances then
