Download Cervical Rib Syndrome - A Case Report -

Cervical Rib Syndrome
- A Case Report Sung Soo Kim, M.D.
Hyeong Cheol Ryu, M.D.
Department of Orthopaedic Surgery, School of Medicine,
Dong-A University, Busan, Korea.
Case Report
• F/16
• C/C: Pain on both lateral neck
esp. when raising arms
• D: 2 years (1 year ago, symptoms
aggravated especially on left side and
radiating pain to elbow)
• P/H: N-C
Case Report
• P/Ex:
– Palpable bony prominence on both lateral
neck(esp. Lt.)
– Tenderness(+/++)
– Radiating pain on arm(+/++)
– Lt. 4th & 5th fingers:
sensory decreased & tingling sensation
– Adson test(-/+)
– LOM on neck: mild
– Thrill(-/-), muscle atrophy(-/-), DTR(NL/NL)
• EMG/NCV: WNL
Roentgenograph
3-dimensional CT
Treatment
• Rt.: conservative Tx.
• Lt.: surgery
– Supraclavicular approach
– Release of ant. scalene muscle
– Removal of 7th cervical rib
Operative Findings
Postop Roentgenograph
Postop Care
• POD 2: intermittent shoulder exercise
start
• Adson test at POD 2: Lt.(-)
• Sx.: radiating pain & tingling sensation
-> improved
• Cx.: none
Cervical Rib Syndrome
• Scalene space, interscalene triangle
– clavicle, first rib, ant. & middle scalene
muscles
• Thoracic outlet syndrome
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Cervical rib syndrome
Scalenus anticus syndrome
Costoclavicular syndrome
Hyperabduction syndrome
Cervical Rib Syndrome
• 1740 Hunauld; first reported
• 1860 Willshire, 1869 Gruber;
conception for diagnosis
• 1861 Coote;
first surgical removal of cervical rib
Cervical Rib Syndrome
• Sx.
– Nerve compression Sx.(MC)
• Traction & compression: C8, T1 nerve root(lower trunk)
• Pain on neck & shoulder
• Radiating pain, paresthesia & numbness: median &
ulnar nerve dermatome
– Arterial compression Sx.
• Pain, claudication, pallor, Raynaud phenomenon
• Peripheral embolism
– Venous compression Sx.
• Coolness, duskiness, venous dilation, edema
• Subclavian vein thromboembolism, peripheral necrosis
Costoclavicular Syndrome
Cervical Rib Syndrome
• Dx.
– Adson test, Wright test and hyperabduction
test etc.(But positive to normal person)
– Roentgenogram, CT, MRI
– Angiogram, Doppler test
– Myelogram
– EMG/NCV
Cervical Rib Syndrome
• Davis & King
– Symptom developed third & fourth decade
• Delayed ossification of cervical rib
• Delayed developmental completion
• Descending shoulder girdle(esp. scalenus
anticus syndrome: middle aged female)
Cervical Rib Syndrome
• Tx.
– Conservative Tx.
• Postural correction
• Physical therapy: sternoclavicular joint &
acromioclavicular joint exercise, scalene
muscle & pectoral muscle stretching
-> costoclavicular space widening
• Shoulder muscle strengthening & home
exercise program
Cervical Rib Syndrome
• Tx.
– Surgical Tx.: no improve to conservative Tx.
• Supraclavicular approach
• Supraclavicular & post. parascapular approach
• Transaxillary approach
(Ant. Scalene muscle, middle scalene muscle,
cervical rib, first rib & part of clavicle)
Cervical Rib Syndrome
• Cx.
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–
–
–
–
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Brachial plexus injury
Subclavian vessels injury
Phrenic nerve injury
Perforation of pleura
Bleeding & hematoma
Infection
Thank you for your attention