Cervical ribs are a rudiment that can be preserved in a person during his intrauterine development. Initially, when the embryo's bone skeleton is formed, it has 29 pairs of costal arches. Gradually, during intrauterine development, the extra ribs die and atrophy. By the time of birth, the fetus has 12 pairs of costal arches with a fully formed chest.
The accessory cervical rib may be located in the area of the seventh or eighth cervical vertebra. It does not have a bone structure. It is formed by fibrous cartilaginous tissue. If compression of the nerve fiber occurs, additional cervical ribs are surgically removed. If there is no pathological influence, then the patient can live with this rudiment for the rest of his life.
In adolescence, additional ribs in the cervical region can provoke curvature of the spinal column. Their attachment to the vertebral bodies is carried out by rigid fixation. When the lung tissue straightens and physical stress on the musculoskeletal system increases, an additional rib can lead to the development of scoliosis.
Additional ribs in the cervical spine in older people lead to drooping of the shoulder line and the development of a hump in the area of the sixth and seventh vertebrae. This significantly worsens the blood supply to the cerebral and coronary systems. Vascular pathologies may develop in the form of coronary heart disease and impaired blood supply to brain structures (stroke or transient).
When an additional rudimentary rib is discovered, the question of its preservation or elimination is always raised. The vertebrologist compares the X-ray and MRI examination data with the patient’s general well-being, the presence of neurological clinical symptoms, etc. The patient cannot independently make a decision about the need to remove this rudiment. If the structure does not have a negative impact, then no one will perform the operation.
It is very important to carry out periodic prevention in order to adapt to existence with this rudiment. There is no muscle tissue between the first and accessory ribs. The rudiment is not attached by ligaments and tendons. It can move freely, which is most often observed with various injuries. Displacement of a rudimentary fibrous rib almost always leads to pinched nerve fibers and the development of pain. There are known cases of cartilage tissue being torn off and freely “walking” near the cervical spine.
Cerebral blood vessels, radicular nerves, and soft tissues suffer from this. It is necessary to take timely measures to fix the additional rib and not allow it to move freely, pinching the radicular nerves.
If you have such a congenital pathology, you can get a free consultation with a vertebrologist in our manual therapy clinic. The doctor will conduct an examination and examine x-ray and MRI images. He will then make individual recommendations for the treatment and prevention of cases of compression of the radicular nerves and surrounding soft tissues.
Description
Cervical ribs are a congenital pathology, characterized by the presence of additional ribs at the cervical level of the spine, which normally should not exist.
During the period of organ formation, the human embryo has 29 pairs of ribs. Only 12 breast pairs reach full development, and the rest undergo reverse development.
The ribs are bony plates that are symmetrically located on the sides of the thoracic spinal column. They participate in the formation of the chest and protect the internal organs located within the chest from mechanical damage. The cervical ribs do not perform any useful functions for humans; on the contrary, their presence can cause discomfort. Normally absent, identifying them is called a developmental anomaly.
Most often, cervical ribs do not bother a person in any way; they can be detected by chance during an X-ray examination. However, with a pronounced process, when there are multiple cervical ribs, the person takes on a certain appearance: the neck is thickened, has a cone-shaped (seal-like) appearance, the shoulders are lowered and look like an extension of the neck.
The following classification is distinguished:
- unilateral/bilateral;
- complete (resemble real ribs and are located on the seventh vertebra) / incomplete (end in soft tissue);
- true (have all the constituent ribs: head, neck, body) / false.
Cervical ribs occur with equal frequency on one or both sides. Significantly more common in women than in men, approximately in a ratio of 5:1.
Extra cervical rib left and right
The extra cervical rib can be one-sided or located symmetrically on both sides. In the case of bilateral pathology, the prognosis is more positive, since with a unilateral location of the rudiment, the patient always develops a lateral curvature of the spinal column in the form of thoracic scoliosis. Secondary deformation of the chest can lead to incomplete development of pulmonary, bronchial and cardiac tissue during fetal development.
The cervical rib on the left leads to disruption of the blood supply to the brain tissue. Tortuosity of the posterior vertebral artery occurs as a result of deformation of the spinal column. The cervical rib on the right is deformed primarily in the chest. Secondary dislocation of the heart, aorta, esophagus, and thyroid gland may be detected. Often in old age, this pathology causes the development of dysphagia and the formation of a diaphragmatic hernia.
An extra rib on the left or right can only be diagnosed using an MRI examination. On an x-ray image, this rudiment appears only if it undergoes the process of deposition of calcium and phosphorus salts on its surface. Calcification can occur due to insufficient blood supply or after aseptic inflammation.
In addition to dividing into unilateral and bilateral pathology, the following classification is carried out:
- true and false rudiments (in the first case, these are full-fledged formations of a dense structure, palpated through the skin);
- complete and incomplete (the first are connected by an epithelial flap to the first thoracic rib);
- fixed and sliding.
Depending on the type and structure of the rudiment, the doctor may recommend preventive treatment using manual therapy methods or removing excess ribs in order to prevent nerve fiber injury.
Symptoms
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Clinical manifestations of the disease will depend on the number of ribs, their length and relationship to the neurovascular bundle. In most cases, there is an asymptomatic course; cervical ribs are discovered accidentally during an X-ray examination. Sometimes a person himself may notice protrusions in the supraclavicular areas of dense consistency or an increase in the size of the neck.
The appearance of symptoms indicates that the cervical ribs are compressing the neurovascular bundle. The so-called compression syndrome develops. Secondarily, the spasmodic anterior scalene muscle, which is also damaged by the cervical rib, is involved in the development of compression syndrome.
The most common symptom is pain. It can be either local acute or widespread. Appears after physical exertion, when turning the head, tilting the neck, raising the arm, lowering the shoulder and shoulder girdle.
The appearance of weakness, decreased muscle strength, decreased or increased sensitivity is also characteristic. Such people cannot work with their arms raised or lift weights. When the subclavian artery or its branches are compressed, the skin becomes pale, it becomes cold and damp to the touch, and swelling may occur. In advanced cases, gangrene of the fingers occurs.
Causes of the anomaly
Disease of the cervical ribs is a congenital pathology. It occurs when, against the background of embryonic development, the embryonic tissue is not completely differentiated. This leads to the preservation of rudiments. They can only be identified through a special examination. X-rays do not always give a complete picture, since the growths have a structure different from bones.
The causes of the appearance of a cervical rib in newborns are:
- alcohol abuse by a woman during pregnancy;
- lack of folic acid in the body during pregnancy;
- excessive physical activity;
- working and living in environmentally unfavorable conditions;
- taking medications that negatively affect the formation of bone tissue in the fetus;
- heredity;
- viral diseases during pregnancy.
The extra rib may be noticed as the child grows. The rudiment will protrude in the neck area. Children with this diagnosis often suffer from colds and have low immunity.
Diagnostics
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If a person has multiple cervical ribs, the doctor may suspect the presence of such a pathology already at the stage of examining the patient. In such people, a thickening of the neck forms, the shoulders drop down and, as it were, continue the neck. Sometimes in the supraclavicular region the ends of the cervical ribs protruding under the skin may be visible. In this case, the doctor palpates a painless or moderately painful tumor-like formation of bone density.
Most often, diagnosis at such an early stage is difficult, since nothing bothers the person, and for a long time he does not even suspect the presence of this type of pathology.
You can suspect the presence of cervical ribs if a person has been bothered by pain for a long time. Pain appears mainly after physical exertion, when turning the neck, tilting the head, raising the arm, lowering the shoulder and shoulder girdle.
To confirm the involvement of the subclavian artery or its branches in the process, the Adson test is performed. For this, the patient is seated on a chair, hands are placed on his knees, after which he is asked to take a deep breath, raise his chin and turn his head in the direction of the lesion. A decrease in pulse and a change in pressure are confirming signs of arterial compression.
A confirmatory diagnostic method is an x-ray examination; the cervical ribs will be visible in the image.
Possible complications
Cervical ribs are removed if they compress the vertebral arteries.
The consequences of the development of pathology appear when the patient ignores the doctor’s recommendations. In severe cases, the risk of developing trophic disorders increases. They can lead to gangrene of the limbs. Since the growths compress the arterial trunk, pathological changes occur in the walls, and the risk of blood clots increases. If the patient is not scheduled for surgery in a timely manner, residual sensory disturbances may occur. Pathology causes restriction of physical activity; a person cannot engage in certain types of activities.
Cervical rib syndrome is a pathology that requires constant monitoring. Timely detection of rudiment growth will help avoid complications.
Treatment
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Since the disease often does not bother you at all and may not make itself felt for a long time, no treatment is prescribed. If symptoms of impact of the cervical ribs on the anterior scalene muscle appear, conservative treatment is carried out. It includes creating peace in the neck, shoulder girdle, upper limb, improving blood circulation through the use of drugs that dilate blood vessels, and relieving spasm of the anterior scalene muscle, which will lead to a decrease in pain.
To alleviate the patient's condition, in addition to medications, physiotherapeutic procedures, therapeutic exercises, and massage are prescribed.
If the presence of compression of the subclavian artery / its branches is confirmed by the Adson test or the presence of corresponding symptoms, then conservative treatment will be insufficient, then surgery is resorted to. Surgical treatment consists of removing the cervical ribs, after which the person will no longer be bothered by compression syndrome.
If you do not consult a doctor in a timely manner to prescribe appropriate treatment, the cervical ribs will continue to compress the subclavian artery, which over time will lead to traumatic damage to the vascular wall. Such a vascular wall becomes susceptible to the development of thrombosis.
Degrees of cervical ribs
Cervical ribs C7 and C8 are always a pathology. But how dangerous it is for human health depends on the degree of proliferation of fibrous tissue and its mobility. In some cases, the rudiments do not appear at all. The patient may not even suspect that he has them. You can see their presence using special equipment.
Cervical ribs of the 1st degree are small in size and rarely cause pathological changes in the surrounding soft tissues. During the examination, it is clear that the cervical ribs of the 1st degree do not exceed the length of the spinous process in size. As a result, they do not exert compressive pressure on tendons, muscles, ligaments and nerve fibers. No treatment required. To improve the condition of the spinal column, it is recommended to conduct preventive osteopathy sessions in order to enhance the diffuse nutrition of the intervertebral cartilaginous discs and do special gymnastics.
The diagnosis of the presence of cervical ribs C7 of the 2nd degree is established if their length exceeds the size of the spinous processes of adjacent vertebrae. In this condition, the patient is recommended to undergo regular examination by a vertebrologist. If the fibrous tissue of the rudiment begins to impede the diffuse nutrition of the intervertebral disc or puts pressure on the soft tissues, then conservative correction using manual therapy methods will be required.
In the third degree of pathology, the rudimentary rib connects to the sternum and has a significant impact on the structure of the chest, the position of the clavicles, the condition of the intervertebral discs, etc. When clinical symptoms of compression appear, surgery is performed to remove the rudiments.
Calcification of additional ribs and their rigid attachment to the sternum is the fourth degree of pathology. It is an absolute indication for surgical removal.
Medicines
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To create rest for the neck, a Shants collar is used. This orthopedic device is a soft fixation device for the cervical spine, the purpose of which is to limit neck mobility. To create rest for the shoulder girdle and upper limb, soft fixing bandages are used.
Physiotherapeutic methods of treatment include electrophoresis with novocaine to eliminate pain. For the same purpose, you can perform a novocaine blockade of the cervicothoracic node.
To reduce spasm of the anterior scalene muscle, drugs such as mydocalm and carbamazepine are used. Their action is aimed at reducing pain by relieving muscle spasm.
To increase the conductivity of impulses through nervous tissue, B vitamins (cyanocobalamin, thiamine) are used.
Vasodilators include xanthinol nicotinate, nicotinate, etc. Vasodilation improves tissue trophism, which helps reduce symptoms and alleviate the course of the disease.
To prescribe surgical treatment, you should contact a surgeon or traumatologist.
Folk remedies
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This disease is a congenital pathology, which can be treated by a qualified doctor. Without taking certain medications, it is impossible to eliminate the symptoms that cause discomfort. Therefore, it is necessary to strictly follow the doctor’s recommendations and not self-medicate. One of the components of therapy is massage, which can be performed independently or with the help of relatives and friends. Initially, you need to familiarize yourself with the correct massage technique from a specialist, and then you can continue the course at home. The same is true with therapeutic exercises. The necessary types of exercises are selected by a qualified specialist, and you can perform them yourself at home.
The information is for reference only and is not a guide to action. Do not self-medicate. At the first symptoms of the disease, consult a doctor.
How to treat rudimentary cervical ribs?
Before treating rudimentary cervical ribs, it is necessary to identify their pathological effect on nearby soft tissues. If there is no pathological effect, then doctors choose a wait-and-see approach. The patient undergoes regular examinations. If negative signs of compression appear, conservative restorative treatment is carried out.
Its main purpose is to fix the rudimentary rib so that it does not put pressure on nearby tissues.
Our manual therapy clinic uses a comprehensive approach to achieve this. The doctor develops an individual course of therapeutic exercises, which, in combination with massage and osteopathy, gives a positive result. Reflexology, laser therapy, kinesiotherapy, physiotherapy and many other techniques can also be used.
If there is no positive effect from conservative treatment, surgery may be required.