II. Epidemiology

  1. Most common neurovascular compression at neck base

III. Anatomy

  1. Cervical rib (extra rib) arises from C7 Vertebra
  2. Rib narrows interval between scalenes
    1. Higher barrier for nerves and vessels to pass over
    2. Compression Worsened by
      1. Shoulder sag (in elderly or Muscle Weakness)
      2. Carrying heavy object in hand
  3. Levels C8 to T1 most commonly affected

IV. Symptoms

  1. Affects hand and inner Forearm
  2. Pain and Paresthesia along Ulnar Nerve course
  3. Hand weakness, numbness, and clumsiness
  4. Associated symptoms may be variably present
    1. Hand cold sensation
    2. Raynaud's Phenomenon
    3. Gangrene

V. Sign

  1. Palpable cervical rib
  2. Tender Brachial Plexus distribution
  3. Muscle Weakness and atrophy (lower trunk)
    1. Interosseus muscles
    2. Hypothenar muscles
  4. Sensation decreased
    1. Ulnar Forearm
    2. Arm
    3. Ulnar 1.5 fingers
  5. Circulatory insufficiency
    1. Swelling
    2. Cold sensation
    3. Distal Cyanosis
    4. Trophic skin change
  6. Adson's Test

VI. Diagnostics

  1. Chest XRay
    1. Extra rib at C7 Vertebra (Often bilateral)
  2. Electromyogram

Images: Related links to external sites (from Google)

Ontology: Cervical Rib Syndrome (C0007856)

Definition (MSH) A condition associated with compression of the BRACHIAL PLEXUS; SUBCLAVIAN ARTERY; and SUBCLAVIAN VEIN at the thoracic outlet and caused by a complete or incomplete anomalous CERVICAL RIB or fascial band connecting the tip of a cervical rib with the first thoracic rib. Clinical manifestations may include pain in the neck and shoulder which radiates into the upper extremity, PARESIS or PARALYSIS of brachial plexus innervated muscles; sensory loss; PARESTHESIAS; ISCHEMIA; and EDEMA. (Adams et al., Principles of Neurology, 6th ed, p214)
Definition (SNOMEDCT) Thoracic outlet syndrome, either nerve or vessel compression, due to a cervical rib
Concepts Disease or Syndrome (T047)
MSH D002573
SnomedCT 54995001, 413577001, 95409006
English Cervical Rib Syndrome, Cervical Rib Syndromes, Syndrome, Cervical Rib, Syndromes, Cervical Rib, cervical rib syndrome (diagnosis), cervical rib syndrome, Anomalous Cervical Rib Syndrome, Cervical Rib Syndrome [Disease/Finding], cervical; syndrome, rib, syndrome; cervical, rib, Cervical rib syndrome -RETIRED-, Cervical rib syndrome, Arterial thoracic outlet syndrome due to cervical rib (disorder), Arterial thoracic outlet syndrome due to cervical rib, Cervical rib syndrome (disorder)
Dutch cervicale ribsyndroom, cervicaal; syndroom, rib, syndroom; cervicaal, rib, Halsribsyndroom, Syndroom, halsrib-
Portuguese Síndrome da costela cervical, Síndrome da Costela Cervical
Spanish Síndrome de la costilla cervical, síndrome de la costilla cervical (trastorno), síndrome de la costilla cervical, síndrome de la costilla cervical - RETIRADO - (concepto no activo), síndrome de la costilla cervical - RETIRADO -, síndrome arterial del estrecho superior del tórax por costilla cervical (trastorno), síndrome arterial del estrecho superior del tórax por costilla cervical, Síndrome de Costilla Cervical, Síndrome de la Costilla Cervical, Síndrome de Opérculo Torácico, Sindrome de Costilla Cervical, Sindrome de Operculo Toracico, Sindrome de la Costilla Cervical
Swedish Halsrevbenssyndrom
Japanese ケイロクショウコウグン, 頸肋症候群, 頚肋症候群
Czech syndrom krčního žebra, Syndrom krčního žebra
Finnish Kaulakylkiluu-oireyhtymä
French Syndrome du défilé costo-claviculaire de Leriche, Syndrome du défilé costoclaviculaire de Leriche, Syndrome de la pince omo-costo-claviculaire, Syndrome de la traversée thoracobrachiale, Syndrome de la côte cervicale
Polish Zespół żebra szyjnego
Hungarian Nyaki borda syndroma
German Halsrippensyndrom
Italian Sindrome della costa cervicale