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Imaging Findings reveal a
cervical rib on the left side with evidence of brachial plexus
compression. Thickening of the cords and trunk of the brachial plexus is
noted on the left.
Diagnosis: Cervical
Rib
Discussion
Cervical rib found in course of routine investigations rarely gives rise
to symptoms, while when they are looked for in a symptomatic patient, they
are rarely found!
Epidemiology :
Occurs in about 0.5% people. It is slightly more common on the right
side, and is commoner in females. It may be associated with
other spinal anomalies.
Pathology :
4 pathological types seen :
Complete rib - articulates anteriorly with the manubrium or the 1st rib.
Incomplete rib - has broad end which expands into a knob like mass.
Incomplete rib with tapering end
with fibrous band attached to the manubrium / 1st rib.
Complete fibrous band.
The fibrous band types give more
pressure symptoms.
Vascular
effects -
Higher arching of Subclavian artery, post - stenotic dilatation, slowing
of blood flow (thrombosis), gangrene (Raynaud's phenomenon)
Neural
effects -
include higher arching of T1 segment of the brachial plexus, pain
& parasthesiae in ilnar area of arm, forearm and hand
Treatment :
If bony rib found -
extra-periosteal resection
If fibrous band - excision and/ or division of scalenus antecus.
If no fibrous band or rib - division of scalenus, and/or excision of
1st rib.
Cervical sympathectomy may be done.
Contribution
Dr. Ashok Raghavan,
Manipal Hospital, Bangalore
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