cervical rib
Introduction
Introduction to the neck rib Most people's neck ribs are degraded, but in some people (0.5%) there are still cervical ribs, and people with neck ribs do not have symptoms. The deformed neck ribs vary greatly in length and length, and can be divided into four categories according to their shape: 1. Small nodular shape, protruding outside the seventh cervical transverse process. 2. An incomplete neck rib connected to the first rib by a fiber bundle. 3. The complete rib is connected to the first rib by the articular surface. 4. Complete ribs with cartilage attached to the first rib and sternum. The neck rib of the seventh cervical vertebra is prone to symptoms, and the cervical rib can occur in the sixth and fifth cervical vertebrae, but it is extremely rare. Cervical rib syndrome rarely occurs in people under the age of 30. basic knowledge The proportion of illness: 0.02% Susceptible people: no special people Mode of infection: non-infectious Complications: swelling, hand and foot cyanosis
Cause
Cervical rib cause
Trauma (20%):
The cause of neck ribs is trauma, shoulder weight, periostitis, shoulder drooping, first rib deformity, anterior scalene hypertrophy, abnormal fiber band and so on.
Pathogenesis
Anatomically, the brachial plexus and the subclavian artery pass through a triangular gap formed by the anterior scalene muscle, the middle scalene muscle, and the upper edge of the first rib, into the ankle, and the lower group of the brachial plexus is located behind the subclavian artery. The two form a neurovascular bundle, the cervical rib is more common in the seventh cervical vertebra, and sometimes also in the sixth cervical vertebra, the length of which varies, generally according to the shape of the neck rib is divided into 4 types: type I, the neck rib is short, just beyond the transverse process, Generally, no symptoms of compression appear. Type II has more neck ribs than transverse processes. The ends are free and can directly interfere with or compress the brachial plexus. Sometimes the fiber band is connected to the first rib. This fiber band compresses the brachial plexus, type III. The neck rib is almost intact, and the fiber band is connected with the first costal cartilage. The brachial plexus and the subclavian artery are often pressed, the type IV and the neck rib are intact, and the costal cartilage is connected with the first costal cartilage, and the brachial plexus is often caused. And the subclavian artery and vein are compressed.
Prevention
Neck rib prevention Stay optimistic and happy. Long-term mental stress, anxiety, irritability, pessimism and other emotions will make the balance of the cerebral cortex excitatory and inhibition process imbalance, so you need to maintain a happy mood.
Complication
Cervical rib complications Complications, swelling, hand and foot palsy
In the severe case, the three lower nerve trunks can be involved. Symptoms of vascular involvement manifest as repeated swelling of the hands and fingers. Cold and cold. pale. Bun and tingling pain. In very severe cases, gangrene at the tip of the finger can occur. When the blood vessels are involved, the subclavian artery is often compressed. Temporary blockage of the radial artery. The upper part of the subclavian artery has increased pulsation and murmur.
Symptom
Cervical rib symptoms Common symptoms Dull pain, sensory disorder, edema, muscle atrophy, paralysis, maternal neck pain, neck instability, upper limbs and shoulders down... The skin is grayish blue when the hand is drooping
Most neck ribs have no symptoms. Only when the blood vessels and nerves are squeezed, the symptoms are manifested. The general sign of the disease is that the patient's shoulders are full of muscles, the supraclavicular fossa is shallow, and sometimes the bulge or hypertrophy is touched. The horn muscles are, in addition, divided into three types depending on the components involved.
Neurological type
(1) hand, shoulder dull pain is the most common first symptom, intermittent, when the upper limbs and shoulders are pulled down, or the weight is aggravated when holding heavy objects, so the patient often lifts the upper limbs on top of the head, subject to The muscles of the VIII neck nerve and the first thoracic nerve are weakened, and the muscles are weakened in the grip, pinching and small movements. In the late stage, the muscles of the hand and the muscles of the fish are atrophied, the innocent reflex changes, and the sensory disturbance is distributed by the ulnar nerve. District-based.
(2) due to sympathetic nerve compression, vasomotor dysfunction occurs, such as skin discoloration when the hand is drooping, grayish blue, sweating, edema, disappear after lifting, cold fingers appear pale, sometimes cervical sympathetic nerve Horner's syndrome.
(3) The neck ribs are sometimes tactile, and compression can cause local pain and radiate to the arm.
2. Vascular type
Less, intermittent upper limb skin color changes or venous engorgement, severe ulcers or gangrene, accompanied by pain or pain disorder, the clavicle can often hear murmur is an important sign, sometimes both sides can be heard, the affected side The sound is loud, the upper limbs are aggravated by the above symptoms, and the anterior scalene test (Adson test): taking the sitting position, the arm is naturally drooping, the head is forced to turn to the side of the disease and then extending, the inhalation is deep and the breath is held up, and the sacral artery pulsation weakens or disappears. , is positive.
3. Neurovascular type
Refers to a mixture of neurological and vascular types.
Middle-aged patients, especially female patients, who have the above clinical manifestations should be suspected of the disease, and further X-ray examination, sometimes the presence of cervical ribs in X-ray films, but may have abnormal fiber bundles to cause compression.
Examine
Neck rib inspection
Examination can be found that the neck base is tender and the cervical vertebra activity is limited. Rotating the cervical vertebra tilts to the healthy side, and pressurization on the cervical rib can cause local tenderness and radiation pain. Occasionally, a full beat can be reached in the supraclavicular area. A percussion can affect a tender mass. A murmur can be heard in the subclavian artery. Generally, it does not affect functional activities. When the symptoms of exercise are manifested, the lesions are more serious, and may be weak, atrophy, and vibrating with the internal muscles of the hands. When the ulnar nerve is compressed, the 4th and 5th fingers may have sensory hypersensitivity, the intermuscular muscle, the non-muscle muscle and the adductor adductor muscle atrophy; the median nerve is affected by the large intermuscular muscle atrophy, but also the biceps, The triceps and tibia periosteal reflexes are reduced.
As seen on the X-ray film, there are neck ribs at the cervical and thoracic vertebrae, and the relationship between the size and shape of the clavicle and the first rib can be seen. The cervical rib syndrome can also be caused by a fiber bundle from the transverse process of the seventh cervical vertebra to the first rib. It is not developed on the photograph, and the compression of the subclavian artery and its site can only be confirmed by angiography.
Diagnosis
Diagnosis of neck ribs
diagnosis
The scapula sag, the high sternum, the first rib high, the low brachial plexus, and the anterior scalene hypertrophy can all cause symptoms similar to the cervical ribs because they both compress the brachial plexus and the subclavian artery to produce symptoms.
The neck ribs occur after the age of 40, more women than men, the right side is more than the left side, even if both sides are also easy to on the right side. The main symptoms are pain, discomfort, and strong neck. The head to the side of the disease can reduce the tension of nerves and blood vessels and relieve pain. Shoulder pain, radiated to the elbow joint, the ulnar side of the forearm, the four or five fingers of the hand. Pain during the day is severe and rest can be relieved. Some have abnormal feelings such as tingling and numbness. When the upper limb is lifted, the pain disappears or is relieved, and when the upper limb is pulled down, the pain is intensified. The change in sensation indicates that the nerve trunk is involved, but in severe cases, the three lower nerve trunks can be involved. Symptoms of vascular involvement are repeated swelling, coldness, paleness, cyanosis, and tingling in the hands and fingers. In very severe cases, gangrene of the fingertips can occur. When the blood vessels are involved, the subclavian artery is compressed and the radial artery is temporarily blocked. The upper part of the subclavian artery is increased in pulsation and murmur. The pathological changes in the third part of the subclavian artery are aneurysmal expansion, and even atheromatization produces complete or partial atresia.
Differential diagnosis
The neck rib is one of the components of the upper thoracic syndrome and should be identified with the following conditions:
1. Rib lock syndrome: the rib lock test is positive, that is, when the shoulder is stressed, the shoulder joint is backwards, because the gap between the first rib and the clavicle is narrowed, the radial artery beat weakens or disappears, which is the identification. The basis of the intrinsic.
2. Pectoralis minor muscle syndrome: is a syndrome caused by compression of the vascular bundle of the chest muscle and the chest wall. It can be positive according to the super-abduction test, that is, shoulder abduction, extension, and traction of the pectoralis minor muscle. Disappear and make a diagnosis.
3. Disc herniation: more occurs in the young, the incidence is more urgent, often has a history of trauma, after traction, the symptoms can be alleviated, myelography shows the intervertebral disc tissue impression.
4. Cervical spondyloarthropathy: X-ray of the cervical spine shows intervertebral foramen stenosis or bone hyperplasia at the posterior edge of the vertebral body.
5. Carpal tunnel syndrome: When the carpal tunnel is compressed, the sensory disorder appears in the median nerve distribution area.
