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.

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

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