Neck pain and cervical ribs

by Michelle Dietrich, OTR/L
(Buffalo, NY, USA)

I had a very large cervical rib removed and anterior scalene muscle removed on the right side due to decreased circulation, numbness, and pain on the medial side of my arm, including hand. I also had a lot of pain in my right scapula (around the borders, but focused on the superior medial angle).

This pain extended into my neck, thoracic outlet, and chest. I also have long standing, frequent issues with both SI joints and Carpal Tunnel on both sides. The right is worse than the left, but it does not really effect my functioning. I was diagnosed with mild scoliosis as a child.

Since the cervical rib has been removed on the right I have experienced a significant decrease in pain especially in the thoracic outlet and upper arm. I am definitely happy with the results of the surgery. My overall pain level on the right has decreased from a 7 to a 2-3.

Prior to the surgery I had multiple diagnostic tests performed. The X-ray showed the large right cervical rib and a smaller left cervical rib. It also showed Arthritis at the left C5 facet joint and the right acromial-clavicular joint. There was also bursitis noted on the right shoulder. An MRI confirmed similar findings.

About 1 week ago I started to have a constant sharp pain at my left C5 facet joint. Since then the pain has spread to be identical to pain I had on the right prior to the surgery. My pain level is fluctuating from a 3-8. I can't pinpoint anything that causes the pain to increase or decrease. I have tried using Flexiril and Ibuprofen with minimal relief.

Along with the other symptoms above I have also had left sided headaches. Just today I started feeling like I'm getting an ear infection and sore throat on the left side only. My glands are tender in that area. Any suggestions would be greatly appreciated.

Hello Michelle,
You have one of the most pernicious and stubborn conditions faced in our clinics. So, be mentally strong. It really does hurt.

Have you had an mri? Sometimes that rib on the left, appears small, but in fact a large fibrous piece of cartailage extends down just like the calcified rib on the right.

Biggie. Does raising your left arm as in hanging the washing, or putting your hand on your head, increase or decrease the pain and tingling in your left arm?

I haven't personally treated a great many very large cervical ribs as you have, they're not very common, but they always seem to be associated with degenerative changes above, and perhaps below c7. It acts a natural movement limiter, so levels above and below have to move extra. Hence degenerative change at c5 facet. Perhaps an old neck injury too, long forgotten.

So you may battle to find a chiropractor who's treated several cervical ribs. In my practice I find patients get relief, but a cure is impossible. Occasional regular treatment is the hallmark, frustrating as that may be.

I work on the whole limb, everything becomes vulnerable because of the change in vascular and neurological input to the arm. It's no coincidence you've had carpal tunnel and shoulder bursitis and ac degeneration. So I work on the hand, wrist, forearm, shoulder and adjust whatever fixations are found in the neck and upper thoracic spine.

So, you're faced with either another op on the left arm or an occasional regular chiropractic treatment on the neck and arm.

The first might come closer to a cure, but it's a big op with attendant risks as you know. And cost.

Have that mri; it's important to diagnose whether the arm pain is coming from that cervical rib or the c spine.

Also you might have your leg length checked. If you have a scoliosis, you may well have a leg length inequality, which goes right through the spine, into the neck.

A once a month sports massage of neck, shoulder girldle and arm?

Don't carry shopping with your left arm at the moment.

I hope this contributes. Let us know how you get on.

Dr b.

Find a good chiropractormay be your next step.

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