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PubMed2006

Cervical rib--preliminary data on diagnosis by ultrasound.

AIM: To determine whether ultrasound is useful in detecting cervical rib. Ultrasound was used to diagnose cervical rib in five patients with neck pain and the findings were compared to those from plain radiography. MATERIALS AND METHODS: Ultrasound was used in 34 patients with pain and stiffness in the neck region. The area concerned was scanned sonographically in both longitudinal and transverse planes. In the sitting position, plain radiographs were obtained after ultrasound examination for comparison and verification. The contralateral side of the neck was used as control. RESULTS: Sonography revealed abnormalities in five patients. Sonography and X-ray confirmed the diagnosis of cervical rib in six patients, whereas one patient had a lipoma of the neck. CONCLUSION: Sonography is an additional and easily available diagnostic modality for the detection of cervical rib in cases of pain and stiffness in the neck region.

Adolescent↗
PubMedDate not supplied

Cervical rib syndrome: a neurosurgical experience with a series of 38 cases.

A series of 38 patients with thoracic outlet syndrome caused by a cervical rib is reviewed after a postoperative follow-up period of 3 to 24 years. The outcome of the operation (anterior scalenotomy and partial to subtotal removal of the cervical rib) is not considered wholly satisfactory; three causes for this were identified: excessive duration of symptoms (mean almost 6 years), insufficient patient work-up and inadequacy of the incomplete removal of the cervical rib. In the presence of a cervical rib, other possible causes of compression of the neurovascular supply to the upper limb should always be considered.

Adolescent↗
PubMed1988

Springing test for differentiating a cervical rib tip from a supraclavicular lymph node.

The palpable tip of a cervical rib can be easily mistaken for an enlarged, hard supraclavicular lymph node. These two swellings, however, can be differentiated by the springing test, in which the clinician applies intermittent pressure on a point corresponding to the surface marking of a cervical rib shaft and checks for transmission of the springing movement to the swelling. The tip of a cervical rib will move but a supraclavicular lymph node will not. This test should be routinely done in all patients having a solitary, hard supraclavicular swelling as it will save many patients from an unneccessary surgical exploration for lymph node biopsy.

Humans↗
PubMed1984

Staging of arterial complications of cervical rib: guidelines for surgical management.

Subclavian artery compression by a cervical rib is an uncommon but potentially disabling condition. A series of 12 patients with 15 arterial lesions is reviewed and a staging system proposed to provide guidelines for managing patients with this condition. Stage I lesions have only arterial stenosis and minor poststenotic dilatation and are managed by thoracic outlet decompression, usually consisting of cervical rib resection. Stage II lesions have intrinsic arterial damage usually with subclavian aneurysm formation and require rib resection, aneurysmectomy, and arterial reconstruction. Stage III lesions present with distal thromboembolic complications and require thrombectomy or embolectomy in addition to thoracic outlet decompression and arterial reconstruction. The anatomic and pathophysiologic bases of the syndrome are reviewed and clinical and angiographic examples of each stage are presented.

Adult↗
PubMedDate not supplied

Cervical rib diagnosis by computerized tomography.

The authors present three cases of cervical ribs discovered by computerized tomography (CT). This represents, to the authors' knowledge, the first such report. The radiologic appearance and relevant clinical findings of cervical ribs will be discussed.

Adult↗
PubMed2006

Klippel-Feil anomaly with associated rudimentary cervical ribs in a human skeleton: case report and review of the literature.

Anomalies of the cervical spine are intriguing anatomically and often come to clinical attention. Fusion of one or more cervical vertebral segments, the Klippel- Feil anomaly (KFA), often causes increased motion at the vertebral segments superior to and inferior to the fused level with a resultant premature wear of these joints. We report an adult male skeleton with fusion of his C6 and C7 vertebral bodies (Type II KFA). A remnant of the intervertebral disc space was noted and bilateral rudimentary cervical ribs were observed emanating from the C7 vertebrae. Excessive joint degeneration was noted between the vertebral bodies of C5 and C6. Following our review of the literature and case report, it appears that there is an increased incidence of the presence of cervical ribs in KFA. We review the literature for coexistent KFA and cervical ribs and discuss their dysembryology.

Abnormalities, Multiple↗
PubMed1982

Isolated fracture of a cervical rib: a case report.

A case of isolated fracture of a cervical rib in a young woman is presented. The mechanism of injury was direct blunt trauma. Histological examination showed changes compatible with a previous fracture of the cervical rib. Literature concerning the incidence, complications and removal of these ribs is reviewed. Closely associated with this anomaly is the thoracic outlet syndrome, a differential diagnosis of which is given.

Adult↗
PubMedDate not supplied

Thoracic outlet syndrome with arm ischemia as a complication of cervical rib.

Thoracic outlet syndrome is the causative factor in less than 5% of patients with upper extremity ischemia. Congenital bony abnormalities (cervical rib) are most often responsible for the arterial complications of this syndrome. This article presents the case report of a patient who presented with ischemia of an upper extremity caused by embolization from subclavian artery stenosis and an aneurysm secondary to cervical rib. The treatment plan included excision of the cervical rib, repair of the subclavian artery aneurysm and a bypass graft which achieved a satisfactory outcome.

Adult↗
PubMed2002

Management of cervical ribs and anomalous first ribs causing neurogenic thoracic outlet syndrome.

OBJECTIVE: Cervical and anomalous first ribs are rare conditions, occurring in less than 1% of the population. This manuscript reviews our management of neurogenic thoracic outlet syndrome (TOS) associated with these congenital anomalies. METHODS: During the past 26 years, 65 operations were performed for abnormal ribs that produced symptoms of TOS. Of these, 54 operations were for neurogenic TOS and are covered in this paper. Indications for surgery were disabling pain and paresthesia and failure to respond to conservative treatment. Surgical technique for neurogenic TOS was supraclavicular cervical rib resection and scalenectomy without first rib resection in 22 cases, supraclavicular cervical and first rib resection in 17 cases, supraclavicular excision of anomalous first ribs in five cases, and transaxillary anomalous first rib resections in two cases (total, 46 cases). Eight reoperations were performed for recurrent TOS in patients who previously had undergone cervical and first rib resections. RESULTS: Neck trauma was the cause of neurogenic symptoms in 80% of patients with cervical or anomalous first ribs. The surgical failure rate was 28% for 46 primary operations. A significant variable in results was the etiology of the symptoms. The failure rate for patients in whom symptoms developed after work-related injuries or repetitive stress at work was 42%, and the failure rates for patients whose symptoms followed an auto accident or developed spontaneously were 26% and 18%, respectively. The failure rate in each etiology group also was affected by the operation performed. The failure rate for cervical rib resection without first rib resection in the work-related group was 75% compared with a failure rate of 38% in the non-work-related group. In contrast, when both cervical and first ribs were resected, the failure rate in the work-related group fell to 25% and in the non-work-related group to 20%. These failure rates for the work-related and non-work-related groups are similar to our failure rates in patients without cervical ribs. CONCLUSION: Surgery for neurogenic TOS in patients with cervical ribs should include both cervical and first rib resection. The presence of cervical or anomalous first ribs in patients with neurogenic TOS does not improve the success rate from surgery compared with patients without abnormal ribs. Neck trauma is the most common cause for neurogenic TOS in patients with abnormal ribs. Cervical and anomalous first ribs are the predisposing factors rather than the cause.

Adolescent↗
PubMed1976

[Cervical ribs. Therapeutic deliberations apropos of 10 cases].

The authors report ten cases of cervical ribs operated upon in 7 patients. The predominantly neurological symptoms and signs were associated with vascular problems in 3 cases, with intermittent compression of the sub-clavian vessels. Treatment consisted of resection of the cervical rib and the first rib via an extra-pleural axillary approach using the technique described by Roos. It gave 10 good results with a follow-up of 6 months to 3 years. The authors emphasise the fact that this pathology falls within the context of compressive syndromes of the root of the upper limb or thoracic outlet syndrome. Such a conception justifies associated resection of the first rib which should give better long term results than simple resection of the extra rib.

Adolescent↗
PubMed1992

Cervical rib variant: report of a case.

It is taught that, when a cervical rib is present, the subclavian vessels and brachial plexus always arch over it. The present case reemphasizes that the brachial plexus may be split by the cervical rib.

Adolescent↗
PubMed1989

[Complete cervical rib. Possible neurovascular implications of the upper limb].

The thoracic outlet syndrome (TOS) is caused by compression of the brachial plexus or subclavian artery or vein in the region of the neck and shoulder girdle. The neurovascular bundle may be compressed at multiple sites: costoclavicular space, interscalene triangle, insertion of the pectoralis minor into the coracoid process. More than 90% of the patients present with neurologic symptoms: pain, paraesthesias or arm and hand weakness and 10% also have vascular problems. The diagnosis of TOS is always difficult and depends on careful clinical study of patients. For the neurological type of TOS, electromyograms, arteriograms and venograms are not helpful. The value of Doppler study and of arteriography is demonstrated in the present case of a woman with a five month history of pain and paraesthesias of the arm and hand, who shoved sudden occlusion of left humeral artery. Roentgenograms showed the presence of a well developed left cervical rib. Doppler study and arteriography showed the compression of subclavian artery with the arm abduction manoeuver. After first rib resection and humeral artery thrombectomy there was a complete return of humeral artery flow and of all neurologic functions. Thus the role of first cervical rib or other bone and muscular structures must be emphasyzed both in the brachial and in the subclavian artery or vein compression. Embolization of the axillary or humeral artery should be corrected as soon as possible when the cervical rib is corrected.

Adult↗
PubMedDate not supplied

Cervical rib mimicking supraclavicular fossa neoplasia. A case report.

A case of fine needle aspiration biopsy done on a cervical rib mistaken for a supraclavicular lymph node is presented. The significance of identifying a cervical rib in the supraclavicular fossa is stressed to avoid subjecting patients to unnecessary invasive procedures.

Biopsy, Needle↗
PubMed1994

Distal arterial reconstruction using Esmarch's bandage technique to salvage upper extremity function in thoracic outlet syndrome caused by cervical ribs: a report of two cases.

We present herein the cases of two patients with thoracic outlet syndrome (TOS) who required arterial reconstruction due to gangrene of the fingers and/or hand. In both patients, the cervical ribs had produced intimal injury of the subclavian arteries, and the successive distal arterial embolism brought about severe ischemia of the affected upper extremity. To treat the TOS, the cervical ribs were resected through a supraclavicular incision. In the first patient, arterial reconstruction was performed from the subclavian artery to the radial collateral artery, a branch of the deep brachial artery, which resulted in minimizing amputation of the gangrenous hand. In the second patient, resection and direct anastomosis of the injured subclavian artery were performed, and bypass surgery from a brachial artery to an interosseous artery was carried out, preserving finger function. Reversed saphenous vein grafts were utilized and Esmarch's bandage technique was applied as a substitute for a vascular clamp in both patients. Following these case reports, we discuss the technique of performing distal bypass in the upper extremities and comment on the usefulness of Esmarch's bandage technique for preserving upper extremity function.

Adult↗
PubMed1990

The ossification of the costal element of the seventh cervical vertebra with particular reference to cervical ribs.

During 16 years of study at Northwick Park Hospital 715 fetuses were radiographed to determine the incidence of skeletal malformations. A technique using low kV and industrial film provided higher resolution radiographs than would have been possible in live births because of dose considerations. Gestational age calculated from LMP and ultrasound findings ranged from less than 18 weeks to 42 weeks. A separate costal element of C7, the possible precursor of a cervical rib, could be identified in 63% of fetuses. Males outnumbered females 403:311 but there was no intersex difference in the presence of such rudimentary cervical ribs with 63 and 64% respectively in each group. Of the 452 cases with separate costal elements, 73% were bilateral. Of the unilateral group 60% occurred on the right and 40% on the left. There was no significant difference in the incidence between the gestational age groups from 20 weeks onwards, confirming that the disappearance of the separate element occurs predominantly after birth, 394 cases (87%) of fetuses had an otherwise normal skeleton.

Cervical Rib Syndrome↗
PubMedDate not supplied

[Vascular complications associated with cervical rib syndrome].

Two cases are reported of vascular complications in the cervical rib syndrome. In one case thrombosis developed in the distal part of the brachial artery, and in both cases compression of the subclavian artery could be demonstrated clinically and during arteriography. Attention is called to the necessity of surgical treatment of patients with evidence of vascular compression in view of the possibility of thrombotic complications. Coexistence of several causes of compression and the relationship of good therapeutic result to removal of all causes is stressed.

Adult↗
PubMed1982

[Acute cerebral circulatory disorders of an ischemic nature in young persons with an accessory cervical rib].

Two young patients with ischemic strokes in the vertebrobasilar basin were observed. The results of the observation verified by brachiocephalic aortography and operation showed that the development of the ischemic lesion because of a circulation disorder in the vertebrobasilar basin in young people could be due to the presence of an additional cervical rib. The leading role in the pathogenesis of those disorders belongs to arterial spasms developing because of irritation of the vegetative structures of the subclavicular artery. The authors consider it reasonable to differentiate between the additional cervical rib syndrome and hypertrophy of the transverse process of the VIIIth vertebra on the one hand and the syndrome of the anterior scalene muscle on the other.

Adult↗
PubMed1970

Wasting of the hand associated with a cervical rib or band.

Nine patients are described with unilateral wasting of the hand muscles associated with elongated C7 transverse processes or with rudimentary cervical ribs. In three patients there was selective wasting of the lateral part of the thenar pad, accompanied by mild weakness of the other hand muscles. In four patients all the hand muscles were wasted, but this was more marked in the lateral part of the thenar pad than elsewhere. In two patients wasting was uniformly distributed throughout the hand. Weakness and wasting in the forearm was only present in four patients and was relatively mild. Sensory loss, when present, affected mainly the inner side of the forearm. Nerve conduction studies revealed no abnormality in the distal part of the median nerve, but some patients had reduced or absent sensory action potentials when the fifth finger was stimulated. In all nine patients a sharp fibrous band was found at operation, which extended from an elongated C7 transverse process or from a rudimentary cervical rib to the region of the scalene tubercle on the first rib. The fibrous band caused angulation of the C8 and T1 roots in five patients, and of the lower trunk of the brachial plexus in three. Pathological changes were frequently visible in affected nerves at the site of angulation. Division of the fibrous band relieved pain and paraesthesiae in eight patients and arrested muscle wasting and weakness in nine patients. There was, however, only slight recovery of power in affected muscles; wasting in the hand appeared to be unchanged after periods of up to eight years.

Action Potentials↗