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2.1
Cervical Rib Syndrome
Arterial Thoracic Outlet Syndrome Due to Cervical Rib

Presentation

Five patients presented with an ischemic upper extremity without thrombosis and underwent transaxillary first rib and cervical rib resection. [ncbi.nlm.nih.gov]

[…] plexopathy, caused by compromise of the distal C8 anterior primary ramus or proximal lower trunk fibers by a congenital band extending from a rudimentary cervical rib to the first thoracic rib; rare disorder, found mostly in young to middle-aged women, which presents [medical-dictionary.thefreedictionary.com]

Material and Methods We present series of 8 patients operated by two consultants in our department. All patients presented with symptoms of thoracic outlet syndrome of varying intensity. [pubs.sciepub.com]

A concurrent neurologic workup strongly suggested that her headache at initial presentation was a migraine and unrelated to ischemia. [omicsonline.org]

Cervical rib with stroke as the initial presentation. Neurol India. 2010;58(4):645‒647. Jusufovic M, Sandset EC, Popperud TH, et al. [medcraveonline.com]

Entire Body System

  • Pain

    […] damage of the arterial lining and production of small emboliResults in no general or local neck symptoms usuallyComplain of pain in the ulnar forearm and hand worse after activity and carrying parcelsMay be weakness and clumsiness and excessive sweating [orthopaedicsone.com]

    […] image shows illustrations related to injury neck thoracic outlet syndrome trauma scalene muscles stretched strained brachial plexus arm nerves subclavian artery clavicle rib cervical swelling spasm compresses scar tissue entrapping symptoms tingling pain [medicalexhibits.com]

    History: 10 year old female with neck pain. Cervical Ribs : Frontal radiograph of the neck reveals bilateral ribs articulating with the C7 transverse processes. The cervical rib on the left is larger (labeled). [radiologypics.com]

    The pain of TOS is sometimes confused with the pain of angina (chest pain due to an inadequate supply of oxygen to the heart muscle), but the two conditions can be distinguished because the pain of thoracic outlet syndrome does not occur or increase when [my.clevelandclinic.org]

    One can even experience facial pain, jaw pain, ear pain and pain on the front of your chest. Unfortunately, the symptoms of neurogenic TOS can be vague and non-specific. [neuropaxclinic.com]

  • Weakness

    […] anterior primary ramus or proximal lower trunk fibers by a congenital band extending from a rudimentary cervical rib to the first thoracic rib; rare disorder, found mostly in young to middle-aged women, which presents with unilateral hand wasting and weakness [medical-dictionary.thefreedictionary.com]

    […] damage of the arterial lining and production of small emboliResults in no general or local neck symptoms usuallyComplain of pain in the ulnar forearm and hand worse after activity and carrying parcelsMay be weakness and clumsiness and excessive sweating [orthopaedicsone.com]

    A 20-year-old male presenting with pain, paresthesia and weakness the of neck, right shoulder and arm was admitted to our hospital. This case was diagnosed as TOS caused by cervical rib by physical and radiological examination. [jstage.jst.go.jp]

    From WikiCNS Rare entity associated with upper extremity weakness (atrophy of the thenar eminence), arm pain (medial forearm), and cervical ribs Occurs typically in young and middle aged females Symptoms due to compressive fibrous band, continuous with [prod.wiki.cns.org]

    […] base of the neck clinical picture: venous vascular TOS • Rapid onset symptoms - Follows limb exertion • Edema and cyanosis of the upper extremity • May also have distended veins in shoulder or chest clinical picture: arterial vascular TOS • Pallor • Weak [quizlet.com]

  • Arm Pain

    From WikiCNS Rare entity associated with upper extremity weakness (atrophy of the thenar eminence), arm pain (medial forearm), and cervical ribs Occurs typically in young and middle aged females Symptoms due to compressive fibrous band, continuous with [prod.wiki.cns.org]

    Snapshot A 25-year-old woman with no history of trauma presents with right arm pain. She reports that her right arm is easily fatigable, especially after she cooks. [medbullets.com]

    The patient may have pain radiating along the nerves of the arm or pain in the neck and shoulder. At times this may be severe causing patient to have a severe burning type of pain along the arm. [doctor.ndtv.com]

    Thoracic outlet syndrome symptoms include neck pain, shoulder pain, arm pain, numbness and tingling of the fingers, and impaired circulation to the extremities (causing discoloration). [medicinenet.com]

    If the patient has a reproduction of arm pain or numbness, consider thoracic outlet syndrome. Radial artery palpation can also diminish in addition to this. [boneandspine.com]

  • Asymptomatic

    RMC Contact us Home » Galleries » Chest X-ray » Anatomical variants » 1 2 3 4 5 6 7 8 9 10 « Previous Galleries Next » Cervical rib Hover on/off image to show/hide findings Tap on/off image to show/hide findings Cervical rib Cervical ribs are usually asymptomatic [radiologymasterclass.co.uk]

    Discussion Patients with cervical ribs resulting in stenosis often remain asymptomatic untilpost-stenotic dilatation with thrombus formation and embolization occurs. [omicsonline.org]

    […] usually bilateral (80%) More common in females The anterior end of the cervical rib may attach to the first rib, the sternum or the cartilage of the first rib; it may be a fibrous band or it may have no anterior attachment Clinical Findings Most are asymptomatic [learningradiology.com]

    The presence of cervical ribs is usually asymptomatic (90 % of patients) and does not need to their removal (Spadlinski et al.). [scielo.cl]

    The asymptomatic thoracic outlet compression syndrome. Handchir Mikrochir Plast Chir. 2006;38(1):51‒55. Palmer OP, Weaver FA. [medcraveonline.com]

  • Falling

    Neurogenic thoracic outlet syndrome can also develop in people who experience trauma to the neck or chest from a car accident or a fall. [nyulangone.org]

    We describe a case of neurogenic thoracic outlet syndrome in a 9-year-old patient where the initial symptoms occurred 2 months after a fall. [karger.com]

    Motor vehicle accidents, traction injuries to shoulder, slipping and falling on floors or ice, blunt injury to base of neck or top of shoulder, or repetitive stress from working on assembly lines are the common causes. [neuropaxclinic.com]

    The responsability of recognizing TOS falls both on the doctor who cures: avoiding confusions as it concerns the diagnosis and the therapeutic indication by finding the correct, clinical diagnosis, and the patient: recovering and avoiding severe complications [tmj.ro]

Cardiovascular

  • Thrombosis

    Five patients presented with an ischemic upper extremity without thrombosis and underwent transaxillary first rib and cervical rib resection. [ncbi.nlm.nih.gov]

    Deep vein thrombosis is more common in the legs. [hopkinsmedicine.org]

    Medicine (Baltimore) 2019; 98(11):e14778 Jiang S, Shen H, … Lu H CONCLUSIONS: Successful treatment of ATOS depends upon urgent assessment, accurate identification of causative factors and compression site and early diagnosis before the event of arterial thrombosis [unboundmedicine.com]

    Findings and Their Effect on Diagnosis and Treatment Comprehensive surgical management of the competitive athlete with effort thrombosis of the subclavian vein (Paget-Schroetter syndrome). Original Text by Clifford R. Wheeless, III, MD. [wheelessonline.com]

    Symonds CP (1927) (2,3) Cervical Rib: Thrombosis of Subclavian Artery. Contralateral Hemiplegia of Sudden Onset, probably Embolic.Proc R Soc Med 20: 1244-1245. [omicsonline.org]

  • Decreased Radial Pulse

    Interpretation - Positive test finding ( Decreased Radial Pulse and/or Distal extremity pain reproduced ) suggests interscalene compression. [physiotherapy-treatment.com]

Eyes

  • Miosis

    […] differential diagnosis of TOS include: cervical radiculopathy, peripheral nerve entrapment, carpal tunnel syndrome, cubital tunnel syndrome, lateral or medial epicondylitis, complex regional pain syndrome, pancoast tumor with possible Horners syndrome (ptosis, miosis [balancechiropracticva.com]

Musculoskeletal

  • Cervical Rib Syndrome

    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 rib syndrome [fpnotebook.com]

    […] is: 8 Images & Illustrations of cervical rib syndrome Translation Find a translation for the cervical rib syndrome definition in other languages: Discuss these cervical rib syndrome definitions with the community: Word of the Day Would you like us to [definitions.net]

    (Adams et al., Principles of Neurology, 6th ed, p214) This graph shows the total number of publications written about "Cervical Rib Syndrome" by people in this website by year, and whether "Cervical Rib Syndrome" was a major or minor topic of these publications [profiles.umassmed.edu]

    But yesterday I was advised chest x-ray where it shows that I am suffering from Cervical Rib Syndrome. I have taken physiotherapy also but nothing worked. [practo.com]

    True neurogenic thoracic outlet syndrome, in which the proximal lower trunk of the brachial plexus is compromised by a radiolucent band extending from a rudimentary cervical rib to the first rib. cervical rib syndrome Pain and paresthesias in the the [medical-dictionary.thefreedictionary.com]

  • Shoulder Pain

    Thoracic outlet syndrome symptoms include neck pain, shoulder pain, arm pain, numbness and tingling of the fingers, and impaired circulation to the extremities (causing discoloration). [medicinenet.com]

    In 1993, he progressively developed shoulder and arm pain along with numbness of upper limb down to 4th and 5th digits. He had gained 10 kgs since the operation. [medschool.lsuhsc.edu]

    A great number of subjects with CTS presented with history of neck and shoulder pain suggestive of TOS. 61 Histopathological studies, on human cadavers, had demonstrated the structural changes induced by cervical rib compression in the lower trunk of [medcraveonline.com]

  • Atrophy of Hand Muscles

    The one exception is that people who have an extra rib (cervical rib) plus arm weakness and atrophy of hand muscles usually have abnormal nerve tests indicating ulnar nerve abnormalities. [rarediseases.org]

    […] of hand muscles along with other neurogenic presentation treated by surgical excision of the rib with band on symptomatic side. [ 6 ] In Our case series youngest patient being matching this case report and establishing the treatment standards. [pubs.sciepub.com]

  • Muscle Spasm

    The clinical examination may be entirely normal or show cervical muscle spasm, tenderness of BP in the supraclavicular area, radial pulse attenuation and occurence of symptoms upon positional maneuvers, sensory or motor deficit. [medschool.lsuhsc.edu]

  • Muscle Contracture

    causing fibrosis and scarring that eventually lead to muscle contractures and consequent scalene hypertrophy. [nshdubai.com]

Neurologic

  • Tingling

    […] yet) This image shows illustrations related to injury neck thoracic outlet syndrome trauma scalene muscles stretched strained brachial plexus arm nerves subclavian artery clavicle rib cervical swelling spasm compresses scar tissue entrapping symptoms tingling [medicalexhibits.com]

    Review of systems revealed a headache, left upper extremity weakness, and a cold sensation and tingling in the left hand. She was otherwise negative for lateralizing symptoms or visual field deficits. [omicsonline.org]

    The resulting scar tissue may cause pain, numbness, tingling, headaches, or weakness in the arm and hand. [nyulangone.org]

    Specific risks and issues of not doing surgery If the compression on the nerves is ongoing, there will be persistence of pain, numbness and tingling. [nshdubai.com]

    If the client experiences the referral of sensory symptoms such as pain, tingling, or numbness into the upper extremity during this test, this is also considered a positive finding and indicates direct compression of the brachial plexus between the anterior [learnmuscles.com]

  • Paresthesia

    A 20-year-old male presenting with pain, paresthesia and weakness the of neck, right shoulder and arm was admitted to our hospital. This case was diagnosed as TOS caused by cervical rib by physical and radiological examination. [jstage.jst.go.jp]

    […] will often prevent the patient from completing the test for the full 3 minutes normal person have discomfort with this manuever, but are able to complete it resolution of pain or paresthesias with dropping of the arms Cyriax release test evaluates the [orthobullets.com]

    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. [profiles.umassmed.edu]

    […] thoracic outlet syndrome Caused by compression of the lower portion of the brachial plexus Clinical manifestations may include pain in the neck and shoulder which radiates into the upper extremity affecting course of the ulnar nerve-hand and inner forearm Paresthesias [learningradiology.com]

  • Paresis

    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. [profiles.umassmed.edu]

  • Numbness of the Hand

    Symptoms include weakness or numbness of the hand; decreased size of hand muscles, which usually occurs on one side of the body; and/or pain, tingling, prickling, numbness and weakness of the neck, chest, and arms. [my.clevelandclinic.org]

  • Cervicobrachial Syndrome

    ( Q77.2 ) cervical or first Q76.5 (syndrome) Syndrome - see also Disease cervical (root) M53.1 ICD-10-CM Diagnosis Code M53.1 Cervicobrachial syndrome 2016 2017 2018 2019 Billable/Specific Code Type 2 Excludes cervical disc disorder ( M50.- ) thoracic [icd10data.com]

Workup

A concurrent neurologic workup strongly suggested that her headache at initial presentation was a migraine and unrelated to ischemia. [omicsonline.org]

An evaluation of the probability of malignant causes and the effectiveness of physicians’ workup. J Fam Pract. 1988;27:373–6. [balancechiropracticva.com]

Treatment

The surgery combined with anticoagulation treatment can improve the treatment outcome of ATOS. PMC Free PDF PMC Free Full Text FREE Publisher Full Text Thirty-Day Outcomes Following Surgical Decompression of Thoracic Outlet Syndrome. [unboundmedicine.com]

What is the treatment for thoracic outlet syndrome? Treatment depends on the underlying cause. [patient.info]

and found no randomized evidence that either treatments is better than no treatment at all. [emedicine.medscape.com]

Patient Population: Prevalence and Epidemiology Knee // Shoulder & Elbow // Hip // Spine // Foot & Ankle // Hand & Wrist Fragility Fractures: Diagnosis and Treatment Shoulder & Elbow The Characteristics of Surgeons Performing Total Shoulder Arthroplasty [mdedge.com]

Medical treatment Anti-inflammatory drugs and analgesics are provided as a conservative means of treatment. [physiotherapy-treatment.com]

Prognosis

What is the outlook (prognosis) for thoracic outlet syndrome? In most people with thoracic outlet syndrome, the outlook is generally good and symptoms often improve over time. [patient.info]

Etiology

A significant variable in results was the etiology of the symptoms. [ncbi.nlm.nih.gov]

[…] thoracic outlet the thoracic outlet is above the first rib and behind the clavicle classified into three types neurogenic (compression of brachial plexus) arterial (obstruction in arteries) venous (obstruction in veins) Epidemiology demographics adults Etiology [medbullets.com]

[…] the problem - there are often 1 or more congenital anomalies that predispose someone to sxs • Accurate diagnosis is based on total clinical picture - dx based on clinical exam, electrodiagnostic studies, arterial and venous studies, and x-rays • Bony etiology [quizlet.com]

[…] neurovascular disorder resulting from compression of the brachial plexus and/or subclavian vessels in the interval between the neck and axilla treatment may be nonoperative or include surgical decompression or a vascular procedure depending on the specific etiology [orthobullets.com]

[…] in 2013 who reported a case of osteoid osteoma of the 1 st rib and case presented as thoracic outlet syndrome. [ 3 ] In 2009 White PW et al discussed in detail the cervical rib causing the arterial type of TOS with subclavian artery compression and etiology [pubs.sciepub.com]

Epidemiology

Patient Population: Prevalence and Epidemiology Knee // Shoulder & Elbow // Hip // Spine // Foot & Ankle // Hand & Wrist Fragility Fractures: Diagnosis and Treatment Shoulder & Elbow The Characteristics of Surgeons Performing Total Shoulder Arthroplasty [mdedge.com]

[…] vessels as it passes through the thoracic outlet the thoracic outlet is above the first rib and behind the clavicle classified into three types neurogenic (compression of brachial plexus) arterial (obstruction in arteries) venous (obstruction in veins) Epidemiology [medbullets.com]

[…] disorder resulting from compression of the brachial plexus and/or subclavian vessels in the interval between the neck and axilla treatment may be nonoperative or include surgical decompression or a vascular procedure depending on the specific etiology Epidemiology [orthobullets.com]

The epidemiological, morphological, and clinical aspects of the cervical ribs in humans. Biomed. Res. Int., 2016:8034613, 2016. [ Links ] Vemuri, C.; McLaughlin, L. N.; Abuirqeba, A. A. & Thompson, R. W. [scielo.cl]

Discu ssion : [ Epidemiology | Clinical Presentation | Clinical Examination | Diagnostic Management | Therapeutic Management] Epide miology: TOS commonly develops during the 3rd or 4th decade, more often in women, under the combination of a peculiar cervical [medschool.lsuhsc.edu]

Pathophysiology

[…] who reported a case of osteoid osteoma of the 1 st rib and case presented as thoracic outlet syndrome. [ 3 ] In 2009 White PW et al discussed in detail the cervical rib causing the arterial type of TOS with subclavian artery compression and etiology, pathophysiology [pubs.sciepub.com]

[…] population demographics females > males (3:1) tend to be thin with long necks and drooping shoulders age 20-60 type neurogenic is most common (95%) vascular may be venous (4%) or arterial (< 1%) more common in athletic males compared to athletic females Pathophysiology [orthobullets.com]

Prevention

The vascular surgeon will find here new variants on the usual operative techniques and much stimulating discussion of complications and their prevention and treatment. [books.google.com]

Screening and prevention of colorectal cancer Source: Finnish Medical Society Duodecim This article is freely available only to users in the UK. [evidence.nhs.uk]

Is it possible to prevent thoracic outlet syndrome? It's possible to prevent thoracic outlet syndrome by maintaining relaxed tissues of the upper chest. [medicinenet.com]

If you develop blood clots you may be prescribed thrombolytics to break them up, and anticoagulants to prevent further clots developing. If these treatments don't help, surgery may be an option. [nhs.uk]

The need of early detection of lesions caused by emboli at an early stage is extremely important to prevent the adverse vascular events. [pjmhsonline.com]

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