Cervical Rib

Inhalation exposure of pregnant Wistar rats to 0.2 mg/m diethanolamine aerosols for 6 h per day on days 6-15 of gestation caused an increased incidence of cervical ribs in the fetuses. No treatment-related malformations were observed (Gamer et al, 1993, cited in Marty et al, 1999). 

The subclavian artery can be damaged by a fractured clavicle or a cervical rib, with later embolization up the vertebral arteries or even up the right common carotid artery (Prior et al. 1979). 

Fig. 2.5. Esophageal atresia with distal tracheoesophageal fistula. The orogastric tube tip is in the hlind-ending esophagus and gas is present in loops ofhowelin the abdomen. Note the right cervical rib and left 13 rib...

Adson AW, Coffey JR (1927) Cervical rib a method of anterior approach for rehef of symptoms by division of the scalenus anticus. Ann Surg 85 839-857... 

Eden KC (1939) The vascular complications of cervical ribs and first thoracic rib abnormalities. Br J Surg 27 111-139 Ellman H (1990) Diagnosis and treatment of incomplete rotator cuff tears. Clin Orthop 254 64-74 Farin PU (1996) Sonography of the biceps tendon of the shoulder normal and pathologic findings. J Clin Ultrasound 24 309-316... 

Os frontale 12 Paired ribs 7 Sternebrae 1-7 Cervical Clavicula Os pubis Humerus Femiu" ... 

Leave fetus on its back examine clavicles examine symmetry and degree of ossification in each region of the spine examine all cervical, thoracic, and lumbar vertebrae (centra, arches, and cartilages) as well as ribs from the ventral aspect and count cervical, thoracic, and lumbar vertebrae as well as ribs. 

After multiday exposures, there was an increased frequency of malformations of the axial skeleton involving the head, sternum, ribs, and vertebrae. About 90% of the fetuses exposed on gestation day 9 had only 6 cervical vertebrae 60% of the fetuses exposed on gestation day 10 had reduced survival and a reduction in the number of thoracic and lumbar... 

Recurrent cervical cancer is associated with bone metastases (Fig. 7.39) in 15%-29% of patients at autopsy [ too, 103]. Typical locations are the bony pelvis as well as the lumbar and other vertebral bodies. Bone metastases in the ribs and extremities are less common. Skeletal metastases typically have an osteolytic character and originate from locally advanced or recurrent tumor in the pelvic sidewall or arise through retrograde tumor spread in patients with para-aor-tic lymph node metastasis [104]. Hematogenous dissemination to the skeleton occurs late. MRl with unenhanced and contrast-enhanced fat-saturated Tl-weighted sequences depicts bone metastases as hyperintense lesions in the low-intensity bone marrow with a high sensitivity. CT primarily shows the extent of osseous destruction. 

Somatic dysfunction of the thorax may occur anteriorly, involving ribs, sternum, or clavicle, or posteriorly, involving costovertebral articulations or the scapulae. Muscle attachments connect the thoracic cage to the cervical spine, the thoracic spine, the lumbar spine, the innominate bones, and the upper extremities. These regions must be evaluated when problems occur in the thoracic cage. 

The lirst rib is probably the rib most commonly involved in somatic dysfunction of all the ribs. It is affected by trauma, stress, and posture as well as by dysfunction ofthe C7-T1 complex. The patient may report "shoulder" pain, stiff neck, upper back or neck pain, and an inability to turn the head while driving. The first rib can impinge the neurovascular bundle as it passes between it and the clavicle through the costoclavicular space. The anterior and middle scalene muscles, which raise the first rib, may likewise compress the brachial plexus when they are in spasm and result in thoracic outlet syndrome symptoms. The patient s symptoms are then described as pain, numbness, or paresthesias ofthe arm or hand on the involved side. The physician needs to be aware that this may cause confusion should the patient demonstrate a herniated cervical disc on magnetic resonance imaging [MRO. The symptoms may be caused by the rib dysfunction rather than the herniated disc, so evaluation ofthe rib for normal motion and treatment of any dysfunction should be performed in these cases. Osteopathic manipulation may save the patient unnecessary surgery. 

This case presents an example of the confusion sometimes caused by a first rib somatic dysfunction in the presence of an MRl-diagnosed cervical disc. Surgery had actually been scheduled for this man. Because the disc was obviously not the cause of his symptoms, it would have ended up being a "failed" surgery. First rib somatic dysfunction can cause symptoms severe enough to incapacitate some patients, with the inability to turn the head toward the dysfunctional rib, pain, or impingement of the neurovascular bundle to the upper extremity. Simply treating with osteopathic manipulation can relieve these symptoms quickly. 

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