CERVICAL RIBS(Keywords: CERVICAL RIBS, cervical rib syndrome, tingling in arms and hands, Thoracic Outlet Syndrome, Inter Scalene Triangle ) Normally speaking, only the twelve thoracic vertebrae have a pair of ribs, beginning at the spine, and attached to the sternum or other lower rib cartilage, and a couple of "floating ribs", forming the ribcage. This vital structure serves to protect the vital organs, particularly the heart, but is moveable to allow breathing. At the lower end of the thoracic spine, quite often the first lumbar vertebra may have a rib, and it may be very significant in the patient who has four (known as a sacralisation) or six (known as a lumbarisation) lumbar vertebrae, instead of the usual five.
SACRALIZATION OF L5 CaseFile ...
CERVICAL RIB SYNDROMEWhy the hype? Because at the cervico-thoracic junction is the critical area where the large artery (the subclavian artery) and a large group of nerves (called the "brachial Plexus") emerge from the chest cavity to supply the arm.The significance is that this syndrome may produce a crazy mixture of both arterial and neurological deficiency in the arm. These ribs are usually rudimentary and of little or no clinical significance, but occasionally a large "space-occupying" cervical rib, originating from the TP of C7, passing through the inter scalene triangle and joining onto the first rib, may cause severe symptoms in the arm.
ADSON'S TESTA vascular and/or neurological restriction in the Inter Scalene Triangle is known as a THORACIC OUTLET SYNDROME ... producing classically pain and tingling in the arm, particularly when lifting the arms as in hanging washing. However a low grade irritation in the inter scalene triangle is often the underlying cause of a FROZEN SHOULDER for example, or a CARPAL TUNNEL SYNDROME ... The classical test to confirm a Thoracic Outlet Syndrome is the test of Adson. Your chiropractor will locate your radial pulse in the wrist, and then ask you to turn your head and breathe in. Does the pulse die away, and return when you return your head to neutral and breathe out?The key signWhat will alert your chiropractor to the fact that all is not well in the state of Denmark, is that s/he simply can't find a Radial artery pulse in the wrist. The first time it happened to me, I was bowled over: how could there be no pulse in the arm? Had my palpation skills suddenly diminished? Nope, a very large Cervical Rib.There's just enough blood getting through to the arm when it's at rest, but start to use the muscles in your arm, or raise your arm so the inter scalene triangle is further diminished in size, and bingo, pain and tingling in the arm. So, of course, it's quite impossible to do Adson's test if you can't locate the Radial pulse. An X-ray is mandatory. CERVICAL RIBWhat is hard to explain is that the Cervical Rib lies silently in the Inter Scalene Triangle for years minding its own business, its owner none the wiser.Then suddenly, one day, for no obvious rhyme or reason, the arm starts to ache and tingle. It may have a Carpal tunnel syndrome appearance, or a frozen shoulder, or tennis arm... the signs and symptoms are very variable.
Arm Pain Case Histories The medical treatment for the offending rib is not nice. The surgeon enters the Inter Scalene Triangle via the arm pit, and surgically removes the offending rib. Frankly, I have no idea how successful the operation is, or what the morbidity is, but it's very close to extremely sensitive structures, the brachial plexus, the Subclavian artery and the apex of the lung. PANCOAST TUMOURTalking of lungs, in you have tingling in the arms and hands, and are a smoker and have a bad cough, your chiropractor should consider a nasty tumour in the apex of the lung that can mimic a Cervical Rib.You do know, don't you, that smoking will knock ten years off your life, and the end will most likely be very S-H-one-T. CHIROPRACTIC CAREIt's not well understood why the Cervical Rib suddenly starts to misbehave. In fact, we think that often the symptoms are not caused by the rib at all - otherwise, if the Cervical Rib was there ten years ago, why was there no pain and tingling in the arms and hands back then?But it is an aggravating factor, the space in the Inter Scalene Trianle is even more limited than normal. The thinking is that there is either a fixation of the first Thoracic Rib, or the Scalene muscles go into spasm because of a Cervical Facet Syndrome or perhaps a whiplash, poor posture at the computer (do you have support under your elbow?), sleeping on your tum, or anyone of a host of other facts. Long journey, sleeping in an aeroplane... Can Chiropractic help?A guarded yes, the hesitation because there aren't enough cases for us to do reliable research, which would tell you that in 80% (or 50%, or 10%) of cases chiropractic management of the Scalene muscles, the cervical vertebrae, the first rib can help you. Here you can follow a casefile currently under treatment. Very successfully, I might say, but a "cure" is unlikely, like many medical conditions and chiropractic conditions too. Cervical Rib CaseFile ...CERVICAL RIB vs THORACTIC OUTLET syndromesCervical ribs are but one cause of the so-called Thoracic Outlet syndrome. Any invasive process, be it a cervical rib or a Pancoast tumour, or an old fracture of the first rib or clavicle can irritate and impinge on the Subclavian artery and the Brachial plexus.But so can a Scalene spasm, be it due to a whiplash, cervical facet syndrome, sleeping in the upright position, long journeys... or an imbalance between the Trapezius msucles and the the smaller Scalenes and SCMs for example. From a chiropractic standpoint, a fixated first rib is another very common cause of the Thoracic Outlet Syndrome, causing scalene muscle spasm, but with no invasion of the inter scalene triangle. CLOTVery occasionally a clot may form in the subclavian vein causing swelling of the whole arm. This is a very serious condition requiring immediate medical attention. Intial treatment would probably be blood thinners and perhaps a stent.Further resection of the first rib, and if present a cervical rib, may be necessary, but it's a difficult operation, not without attendant dangers: "1st rib resection of my left shoulder (2 months ago) has squared up my shoulders but has increased the strain on my neck, mid and lower back. Nerve damage sustained due to the operation has serverely effected the first three fingers with hyper sensitivity, signs of muscle wasteage around the base of the thumb and forearm is apparent. Overall I have ailments from the finger tips through the wrist up my arm, within my elbow and shoulder down the spine,at the base of my back through my left hip joint and in the back of the knee." Letter received at Chiropractic Help. USEFUL LINKSGo from CERVICAL-RIB to CHIROPRACTIC HELP home page …Go from CERVICAL RIBS to NECK PAIN home page … MONTHLY NEWSLETTERBACK ISSUES(PS. If you find them irrelevant to your needs or an exercise in tedium, one click will UNsubscribe you.) CERVICAL RIBSDid you find this page useful? Then perhaps forward this link to a friend suffering from tingling in the arms and hands. |
