The significance of cervical ribs in thoracic outlet syndrome
One of the possible causes for vascular or neurogenic thoracic outlet syndrome is the presence of a cervical rib. Cervical ribs are located between the C7 vertebrae and the first rib and can vary in length. Their incidence in the general population varies between 0.2 and 1.0%.
Commonly, four different types are distinguished: 1) those only a little longer than the transverse process; 2) ribs extending beyond the transverse process almost attaching to the first rib; 3) cervical ribs attaching to the first rib via fibrous or cartilaginous tissue; and 4) cervical ribs fusing to the first rib. Especially type 3 and 4 often cause symptoms such as pain, paraesthesia and weakness in the affected arm.
According to the authors, the preferable surgical intervention for this condition includes first rib resection and scalenectomy – either via a transaxillary or a supraclavicular approach, depending on the necessity of additional vascular surgery – combined with cervical rib resection. This releases the subclavian artery and vein and the brachial plexus, and can thereby resolve symptoms. > From: Chang et al., J Vasc Surg 57 (2013) 771-775. All rights reserved to the Society for Vascular Surgery.