What is a cervical rib?

The human skeleton has 24 ribs, 12 on each side, which are attached to the spine at the back. The top seven ribs, called the true ribs, are connected in front to the breastbone, or breastbone; the next three ribs are joined together by cartilage; and the two lower ribs, called the floating ribs, are not joined in front. In rare cases, an extra rib is found in the neck, between the lower neck vertebra and the first rib. This extra rib is called the cervical rib. A cervical rib usually appears on one side, although occasionally a person may have one on each side.

A cervical rib is a congenital condition, meaning it is present at birth, although it is often not diagnosed until adolescence or later, when symptoms and complications are more likely to arise. This condition, which appears more often in women than in men, is usually asymptomatic, meaning there are no physical signs that it exists. In some cases, however, problems arise because the rib presses against the blood vessels or muscles that run from the neck to the arm. To determine if a cervical rib is present, an X-ray, ultrasound, magnetic resonance imaging (MRI), or other computed tomography (CT) scans are required.

When symptoms do occur, they often include pain in the neck and arm, tingling in the arm and hand, and muscle weakness or atrophy in the arm. This can be caused by the rib pressing against the blood vessels and muscles that run from the neck to the arm. One vessel that can be affected is the subclavian artery, the part of the main artery to the arm that runs under the collarbone or shoulder blade. Symptoms of this complication include pain in the forearm, coldness in the hand and arm, numbness in the fingers, and a bluish or white tint to the arm.

Most people who have a cervical rib do not show any symptoms and are unaware of the condition. In such situations, treatment is not required. Other patients begin to experience symptoms as they enter middle age, perhaps as a result of changes in posture and muscle tone.

If symptoms are mild, physical therapy can help strengthen the shoulder muscles and open up the area through which vessels and nerves travel to the arm. Postural and strengthening exercises, ultrasound, electrostimulation therapy, heat therapy, and chiropractic manipulation are often effective treatments. In some cases, muscle relaxants and anti-inflammatory medications are also prescribed to relieve pain.

In cases where symptoms are extreme or a decreased blood supply poses a risk to the arm, a procedure called a rib resection may be recommended to remove the extra rib. Surgical removal of the ribs from the clavicle began in the early 1900s, but this difficult procedure often resulted in nerve and vascular damage. In recent decades, rib resection has become safer and more successful with the introduction of endoscopic surgical procedures that use small incisions, video, and computers.

The complications that can accompany a cervical rib are similar to those of other conditions. If a person experiencing these symptoms discovers that he has a cervical rib, he should not necessarily assume that the rib is causing him discomfort. It is important to have a complete physical exam to make sure there is not a more serious condition before developing a treatment plan.

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