Cervical rib

A GENERAL OVERVIEW OF A SPECIAL PATHOLOGY

1. Cervical RIB Presented by – Nikhil Govind Moderated by – vijay Samuel Raj

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3. Table of contents Introduction Structure and function symptoms Diagnosis Differential diagnosis Medical management Surgical management Physiotherapy management 3

4. Cervical rib  also known as " neck rib " in cervical region “and is an extra rib which grows from the base of the neck just above the collarbone .  It is a congenital overdevelopment of transverse process of cervical spine vertebra 4

5.  It can be on right, left or both sides and may be floating with no connection 5

6. Structure and function the cervical rib consists of a head, neck, and tubercle . t is attached posteriorly to the first rib by a fibrous band near in the insertion of the anterior scalene muscle  Cervical rib has no physiological function 6

7. There are four types of cervical ribs: Type 1: Complete rib that articulates with the first rib or manubrium Type 2: Incomplete rib with a free distal tip Type 3: Incomplete rib with a distal fibrous band attachment Type 4: Short piece of bone extending beyond the C7 transverse process 7

8. symptoms Local Symptoms Tender supraclavicular lump which is bony hard and is fixed when palpated. Sensory Symptoms Tingling in hands or fingers; confined either to radial side or ulnar side or sometimes involve even whole hand. Pain which may radiate down the arm. 8

9. Vascular symptoms Cold and clumsy extremities, particularly the fingers. Skin colour changes to blue associated with trophic changes. There is rare risk of gangrene. Radial pulse becomes feeble or may even be absent. Motor Symptoms Loss of hand grip. Tendency of dropping things from the hand. Wasting of palmar muscles 9

10. Diagnosis Imaging Special tests 10

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12. Special tests Adson's test is a provocative test for Thoracic Outlet Syndrome accompanied by compression of the Subclavian artery by a cervical rib  12

13. Technique Starting Position   The test can be performed with the patient in either sitting or standing with their  elbow  in full extension 13

14. Procedure   • The arm of the standing (or seated) patient is abducted 30 degrees at the shoulder and maximally extended. • The radial pulse is palpated and the examiner grasps the patient's wrist. • The patient then extends the neck and turns the head toward the symptomatic shoulder and is asked to take a deep breath and hold it. • The quality of the radial pulse is evaluated in comparison to the pulse taken while the arm is resting at the patient's side. • Some clinicians have patients turn their head away from the side tested in a modified test. 14

15. Positive Test   The test is positive if there is a marked decrease, or disappearance, of the radial pulse. It is important to check the patient's radial pulse on the other arm to recognize the patient's normal pulse. A positive test should be compared with the non-symptomatic side 15

16. Shoulder Abduction test:  It is an  orthopaedic  test used to diagnose a cervical nerve root injury or cervical disc herniation . It is performed by having the patient abduct their shoulder and place their hand on top of their head. A positive test will involve a decrease in radiculopathy or pain. 16

17. Differential Diagnosis Herniated  cervical disk Cervical spondylosis Peripheral neuropathies Raynaud's disease Syringomyelia Polio Muscular dystrophy Motor neuron disease 17

18. Management Medical Management  Surgical Management 18

19. Medical Management Anti-inflammatory drugs Analgesics 19

20. Surgical Management Removal of extra segment. Complete resection of the rib. Dividing the scalene group of muscles. Resection of cervical ribs for thoracic outlet syndrome. 20

21. Physiotherapy management Pain relief: Short wave diathermy is used but it is contraindicated in case of sensory impairments. To improve distal circulation: Gripping exercise. Strengthening exercises of whole arm to improve tone, power and endurance. Posture Correction. Specific exercises like Self resisted scapular elevation and adduction. Endurance training. Progressive resistance exercises for shoulder girdle muscles 21

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23. REFERENCES Physiopedia Jayanth joshi 23

24. REF  Cervical Rib. Healthily. Available from https://www.livehealthily.com/neck-pain/cervical-rib [last accessed 05/11/2020] ↑  Cervical Rib. NHS. Available from https://www.nhs.uk/conditions/cervical-rib/ [ last accessed 05/11/2020 ↑   Fliegel BE, Menezes RG. Anatomy, Thorax, Cervical Rib.[updated 2020 Aug 22]. In:StatPearls [Internet].Treasure Island(FL): stat pearls publishing; 2020 jan .  Dr. Colin Tidy. Cervical Rib. Thoracic outlet syndrome. Patient. Available from https:// patient.info/bones-joints-muscles/cervical-rib-thoracic-outlet-syndromelast accessed 05/11/2020]]  Giles, Lynton G. F. (2009-01-01), Giles, Lynton G. F. (ed.), "Case 67 Cervical ribs "   100 Challenging Spinal Pain Syndrome Cases (Second Edition) , Edinburgh: Churchill Livingstone, pp. 311–314, doi:10.1016/b978-0-443-06716-7.00067-0, ISBN    Guttentag , Adam; Salwen , Julia (1999). "Keep Your Eyes on the Ribs: The Spectrum of Normal Variants and Diseases That Involve the Ribs".  RadioGraphics .  19  (5): 1125–1142. doi:10.1148/radiographics.19.5.g99se011125. PMID 10489169   Tani , Edneia M.; Skoog , Lambert (2008-01-01), Bibbo , Marluce ; Wilbur, David (eds.), "CHAPTER 22 - Salivary Glands and Rare Head and Neck Lesion",   Comprehensive Cytopathology (Third Edition) , Edinburgh: W.B. Saunders, pp. 607–632, ISBN.   Physio Vibes. Cervical Rib And Physiotherapy Management. Available from https:// www.youtube.com/watch?v=y_fpaqRg69M[last accessed 05/11/2020 ] 24

25.  Physiotherapy treatment.com. Cervical Rib Syndrome. Available from https://www.physiotherapy-treatment.com/cervical-rib.html[last accessed 05/11/2020] Cervical Rib. Available from https://samarpanphysioclinic.com/2018/03/30/cervical-rib [last accessed 05/11/2020]   Balan , Nisha Sharma, Anu (2008).  Get through FRCR part 2B : rapid reporting of plain radiographs . London: Royal Society of Medicine. ISBN .  Cervical Rib. Learning Radiology. Available fromhttps://learningradiology.com/notes/chestnotes/cervicalrib.htm[last accessed 05/11/2020]  Dr. Bradshawdc . Cervical Rib. Available from https://www.youtube.com/watch?v=cI4-kCNfLcslast accessed 05/11/2020] 25