bubble_chart Overview

In humans, cervical ribs have degenerated, but in some individuals (0.5%), cervical ribs remain in the philtrum. Not all people with cervical ribs exhibit symptoms. The length of malformed cervical ribs varies greatly and can be classified into four types based on shape: 1. Small nodular, protruding laterally from the transverse process of the seventh cervical vertebra. 2. Incomplete rib, connected to the first rib by a fibrous band. 3. Complete rib, connected to the first rib by an articular surface. 4. Complete rib, connected to the first rib and sternum by cartilage. Cervical ribs originating from the seventh cervical vertebra are most likely to cause symptoms. Cervical ribs can also occur in the sixth or fifth cervical vertebrae, but this is extremely rare. Cervical rib syndrome rarely occurs in people under the age of 30.

bubble_chart Clinical Manifestations

The scapular leukorrheal disease, drooping, high sternum, elevated first rib, low brachial plexus, and hypertrophy of the anterior scalene muscle can all cause symptoms similar to cervical ribs because they compress the brachial plexus nerve and subclavian {|###|} pulse, leading to symptoms.

Cervical ribs are more common after the age of 40, with a higher incidence in women than in men, and more frequent on the right side than the left. Even when present bilaterally, symptoms are more likely to occur on the right. The main symptoms include pain, discomfort, and neck stiffness. Tilting the head toward the affected side can reduce the {|###|} tension of nerves and blood vessels, thereby alleviating pain. Shoulder pain may radiate to the elbow joint, the ulnar side of the forearm, and the fourth and fifth fingers of the hand. Pain is severe during the day but may ease with rest. Some patients experience abnormal sensations such as tingling and numbness. Raising the upper limb may relieve or reduce the pain, while pulling it downward exacerbates the pain. Sensory changes indicate traction on the lower nerve trunks, and in severe cases, all three lower nerve trunks may be affected. Vascular symptoms include recurrent swelling, coldness, pallor, cyanosis, and {|###|} stabbing pain in the hand and fingers. In extreme cases, fingertip gangrene may occur. When blood vessels are involved, compression of the subclavian {|###|} pulse, temporary blockage of the radial {|###|} pulse, increased pulsation and murmurs in the supraclavicular portion of the subclavian {|###|} pulse may be observed. Pathological changes include aneurysmal dilation or even atherosclerosis of the third portion of the subclavian {|###|} pulse, leading to complete or partial occlusion.

In many cervical rib syndromes, sympathetic nerve symptoms may appear, which are difficult to distinguish from vascular symptoms.

Examination may reveal tenderness at the base of the neck and limited cervical spine mobility. Rotating the cervical spine to tilt toward the unaffected side or applying pressure to the cervical rib area can elicit local tenderness and radiating pain. Occasionally, a full, pulsating mass may be palpated in the supraclavicular region. A tender mass may also be felt upon palpation. A murmur may be heard over the subclavian {|###|} pulse area. Functional activities are generally unaffected, but when motor symptoms appear, the condition is more severe, possibly manifesting as weakness, atrophy, and tremors in the intrinsic hand muscles. Compression of the ulnar nerve may cause hypersensitivity in the fourth and fifth fingers, atrophy of the interosseous muscles, hypothenar muscles, and adductor pollicis; involvement of the median nerve may lead to thenar muscle atrophy, as well as reduced biceps, triceps, and radial {|###|} membrane reflexes.

X-ray findings may reveal cervical ribs at the cervicothoracic junction, showing their size, shape, and relationship to the clavicle and first rib. The cervical rib syndrome may also be caused by a fibrous band extending from the transverse process of the seventh cervical vertebra to the first rib, which is not visible on X-rays and can only be confirmed by angiography to identify the compression and location of the subclavian {|###|} pulse.

bubble_chart Treatment Measures

First, conservative therapy is adopted. For most cases, conservative treatment can relieve pain, including exercising the shoulder muscles to elevate the shoulder and changing the patient's work and sleep habits to prevent shoulder drooping. Tuina therapy can also alleviate symptoms in some cases.

**Surgical Therapy:** A supraclavicular incision is made, creating a 6–8 cm transverse incision in the supraclavicular fossa, starting superolaterally to the sternoclavicular joint and extending upward and backward. The platysma muscle is divided beneath the skin incision, and the clavicular insertion of the sternocleidomastoid muscle is identified and severed. The external jugular vein and the transverse scapular artery, as well as the transverse cervical artery, are located anterior to the anterior scalene muscle and ligated separately. The omohyoid muscle is divided, and the phrenic nerve, running obliquely downward, is identified anterior to the anterior scalene muscle. It is freed and retracted medially. The anterior and posterior borders of the anterior scalene muscle are dissected, and it is severed at its attachment point, avoiding injury to the subclavian vein, which lies anteroinferior to the anterior scalene muscle. Posterior to the anterior scalene muscle are the subclavian artery and the brachial plexus. Care is taken to determine whether cutting the anterior scalene muscle relieves pressure on these structures. The neurovascular bundle medial to the middle scalene muscle is carefully examined for any fibrous or tendinous bands compressing these structures, as well as for any anomalies in the scalene muscles. The presence of a cervical rib or an excessively large transverse process of the seventh cervical vertebra is also explored. The cervical rib passes through the space between the anterior and middle scalene muscles, and the lowest nerve root of the brachial plexus and the subclavian artery are compressed into an arch as they cross the cervical rib. The goal of surgery is to relieve compression on the nerves and blood vessels. The cervical rib is carefully freed, and part or all of it is excised. All fibrous bands are removed. If the middle scalene muscle is found to constrict the brachial plexus, sufficient muscle is excised to relieve the compression. Care must be taken, as in some cases, part of the brachial plexus may penetrate the scalene muscles, and blind cutting of the scalene muscles may injure the brachial plexus. After surgery, the wound is closed with a rubber drain, which is removed after 24 hours. Sutures are removed after one week.