Cervical Rib Syndrome - A Case Report -

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Cervical Rib Syndrome- A Case Report -

• Sung Soo Kim, M.D.
• Hyeong Cheol Ryu, M.D.
• Department of Orthopaedic Surgery, School of
  Medicine, Dong-A University, Busan, Korea.

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Case Report

• F/16
• C/C Pain on both lateral neck
• esp. when raising arms
• D 2 years (1 year ago, symptoms aggravated
  especially on left side and radiating pain to
  elbow)
• P/H N-C

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Case Report

• P/Ex
• Palpable bony prominence on both lateral
  neck(esp. Lt.)
• Tenderness(/)
• Radiating pain on arm(/)
• Lt. 4th 5th fingers
• sensory decreased tingling sensation
• Adson test(-/)
• LOM on neck mild
• Thrill(-/-), muscle atrophy(-/-), DTR(NL/NL)
• EMG/NCV WNL

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Roentgenograph
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3-dimensional CT
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Treatment

• Rt. conservative Tx.
• Lt. surgery
• Supraclavicular approach
• Release of ant. scalene muscle
• Removal of 7th cervical rib

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Operative Findings
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Postop Roentgenograph
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Postop Care

• POD 2 intermittent shoulder exercise
• start
• Adson test at POD 2 Lt.(-)
• Sx. radiating pain tingling sensation
• -gt improved
• Cx. none

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Cervical Rib Syndrome

• Scalene space, interscalene triangle
• clavicle, first rib, ant. middle scalene
  muscles
• Thoracic outlet syndrome
• Cervical rib syndrome
• Scalenus anticus syndrome
• Costoclavicular syndrome
• Hyperabduction syndrome

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Cervical Rib Syndrome

• 1740 Hunauld first reported
• 1860 Willshire, 1869 Gruber
• conception for diagnosis
• 1861 Coote
• first surgical removal of cervical rib

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Cervical Rib Syndrome

• Sx.
• Nerve compression Sx.(MC)
• Traction compression C8, T1 nerve root(lower
  trunk)
• Pain on neck shoulder
• Radiating pain, paresthesia numbness median
  ulnar nerve dermatome
• Arterial compression Sx.
• Pain, claudication, pallor, Raynaud phenomenon
• Peripheral embolism
• Venous compression Sx.
• Coolness, duskiness, venous dilation, edema
• Subclavian vein thromboembolism, peripheral
  necrosis

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Costoclavicular Syndrome
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Cervical Rib Syndrome

• Dx.
• Adson test, Wright test and hyperabduction test
  etc.(But positive to normal person)
• Roentgenogram, CT, MRI
• Angiogram, Doppler test
• Myelogram
• EMG/NCV

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Cervical Rib Syndrome

• Davis King
• Symptom developed third fourth decade
• Delayed ossification of cervical rib
• Delayed developmental completion
• Descending shoulder girdle(esp. scalenus anticus
  syndrome middle aged female)

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Cervical Rib Syndrome

• Tx.
• Conservative Tx.
• Postural correction
• Physical therapy sternoclavicular joint
  acromioclavicular joint exercise, scalene muscle
  pectoral muscle stretching
• -gt costoclavicular space widening
• Shoulder muscle strengthening home exercise
  program

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Cervical Rib Syndrome

• Tx.
• Surgical Tx. no improve to conservative Tx.
• Supraclavicular approach
• Supraclavicular post. parascapular approach
• Transaxillary approach
• (Ant. Scalene muscle, middle scalene muscle,
  cervical rib, first rib part of clavicle)

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Cervical Rib Syndrome

• Cx.
• Brachial plexus injury
• Subclavian vessels injury
• Phrenic nerve injury
• Perforation of pleura
• Bleeding hematoma
• Infection

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Thank you for your attention