Cervical rib deformity
Introduction
Introduction to cervical rib deformity Among the patients with thoracic outlet syndrome, about half of them are caused by the 7th cervical rib deformity or the transverse process, which has not only corresponding characteristics in clinical practice, but also treatments due to other causes. 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. basic knowledge Sickness ratio: 0.05% Susceptible people: 20 to 30 years old Mode of infection: non-infectious Complications: thoracic outlet syndrome
Cause
Cause of neck rib deformity
(1) Causes of the disease
The cause is unknown.
(two) pathogenesis
With the evolution of humans, the ribs on the cervical vertebrae have long since degenerated, but 2% of normal people still have cervical ribs remaining on the seventh cervical vertebrae. Most of them have no clinical symptoms and are only found in physical examination.
The shape of the neck ribs is different, and can be divided into the following four types from pathological anatomy.
Complete neck ribs (27%):
Refers to a more typical rib shape, the front of the costal cartilage and the sternum or the first rib joint, generally seen in the seventh cervical vertebrae, rarely occurred in the sixth or fifth cervical vertebrae.
Semi-complete neck ribs, incomplete neck ribs (25%):
Similar to the former, except that the cartilage joint surface is connected to the first rib. Incomplete neck ribs, the shape of which is similar to that of the ribs, but the development is shorter and shorter, and the front is connected with the first rib by a fibrous band.
Residual neck ribs (15%):
It refers to the residual ribs which are only about 1.0cm long outside the transverse process of the seventh cervical vertebrae, and the tips are mostly attached to the first rib by fiber bundles.
In addition to the above four types, there are some cases in which the 7th cervical transverse process is too long, which also constitutes one of the pathological anatomical factors of thoracic outlet stenosis.
This congenital malformation does not occur in the early postnatal period, usually more than 20 years old, especially in women, due to the growth and development of the human body, causing the scapular slings to sag gradually, combined with the increase in labor load, the anterior scalene muscle The tensile stress increases, the internal pressure at the thoracic outlet increases, and finally the brachial plexus and the subclavian artery are compressed and a series of clinical symptoms appear.
Prevention
Cervical rib deformity prevention
Increase shoulder training, gymnastics, shoulder load and massage to increase shoulder strength, especially for scapular levator training. Allow the patient to place the affected upper limb in the upper position at rest, especially in bed, to relieve and counter the sagging effect of the scapula.
Complication
Cervical rib malformation complications Complications thoracic outlet syndrome
Can be complicated by thoracic outlet syndrome.
Symptom
Symptoms of neck rib deformity Common symptoms Powerless muscle atrophy Finger or arm thorn... Hair upper limb and shoulder down... Swelling neck short
1. General characteristics
(1) Age of onset: It is often caused by 20 to 30 years old, and is also affected by the onset of 14 years old and after 50 years of age.
(2) Gender: Females are more than males. The ratio of the two is about 4:1. This may be related to the early development of women, the more sagging of the shoulder straps and the more frequent participation in housework.
(3) Side: The right side is more than the left side. The ratio of the two is about 3:1. The reason why the right side is more common is that the average person is right-handed and the right hand is more labor-intensive. In addition, it is also right. The lateral brachial plexus is related to the ribs and the lower subclavian artery.
(4) Occupation: Those who have more physical labor are more likely to develop the disease.
2. Onset symptoms
Depending on the degree of pathological anatomical changes, the location of the compressed tissue and individual differences, the onset symptoms are not consistent, among which are more common:
(1) The ulnar side of the forearm and the numbness of the little finger: the most common, accounting for about 40%, mainly due to the ulnar nerve symptoms caused by the stimulation of the brachial plexus.
(2) The object is easy to fall and the hand is weak: it is also more common, accounting for about 30%, caused by the fiber involved in the median nerve in the brachial plexus.
(3) Small fish muscle atrophy: also caused by the ulnar nerve, which accounts for about 10%.
(4) Others: including the swelling of the hand, the stupid feeling, the weakening of the radial artery and the soreness of the affected limb, etc., accounting for about 20%.
3. Clinical signs
(1) full feeling of the supraclavicular fossa: under normal circumstances, the bilateral supraclavicular fossa is mostly symmetrical concave. If there is a cervical rib, it can be found that the affected side (also bilateral) the supraclavicular fossa disappears, even Slightly upwards, full of shape.
(2) Positive compression test of the supraclavicular fossa: the surgeon uses the large intermuscular muscle of the hand to compress the supraclavicular fossa of the affected side. As the brachial plexus is squeezed between the cervical rib and the anterior scalene muscle, it may cause Pain and numbness of the arm, this is positive, especially when deep inhalation.
(3) Muscle atrophy: mainly in the small intermuscular muscles of the hand, the ulnar muscles of the interosseous muscles and forearms (when the ulnar nerve is involved), followed by the large intermuscular muscles innervated by the median nerve, occasionally occurring in Biceps and triceps.
(4) Hand ischemic symptoms: If the cervical ribs cause compression of the subclavian artery, swelling of the hand may occur, chills, paleness and tingling; in severe cases, finger cyanosis may occur, and even the tip of the finger may be gangrene-like.
(5) Adson sign: positive has diagnostic significance, but negative can not be denied diagnosis. The test method is: the patient sits on the stool, takes deep breathing, and maintains a deep inhalation state; Turn the head; the examiner holds the patient's lower jaw (ankle) with one hand and touches the radial artery with another hand; after that, the patient is forced to maneuver the lower jaw and fight against the examiner's hand, such as inducing or aggravating neurological symptoms, or radial artery If the beat weakens and disappears, it is positive.
1. General clinical features: more common in young women over the age of 20, and good for the right side.
2. Onset symptoms: mainly manifested as ulnar nerve or median nerve involvement and blood supply blocked hand symptoms.
3. Clinical examination: preliminary judgment can be made according to the variation of the supraclavicular fossa, tenderness, and the pressure test, the results of the Adson sign.
4. X-ray film: can clearly show the length of the neck rib deformity or the 7th cervical transverse process is too long.
Examine
Examination of neck rib deformity
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 and diagnosis of cervical rib deformity
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
Peripheral neuritis
The clinical symptoms of this disease are more limited, mainly manifested as nerve ending symptoms, ulnar neuritis is more common, because there is no full supraclavicular fossa, tenderness and pressure test and Adson sign positive, etc., easy to identify.
2. Anterior scalene syndrome
Because the anterior scalene itself is hypertrophied and contracted, the first rib is lifted up, causing compression of the brachial plexus and subclavian artery. The clinical manifestations of the two are basically the same, but the appearance of the supraclavicular fossa is basically normal. X-ray plain film without neck rib deformity can be seen, because the treatment principles of the two are basically the same, so do not need to be identified.
3. Nerve root cervical spondylosis
Cervical spondylotic radiculopathy, especially the lower cervical spur hyperplasia, can cause symptoms similar to cervical rib deformity when the 7th and 8th cervical nerves are involved, but the signs and X-ray films are completely different and easy to identify. .
4. Acute cervical disc herniation
Although it can cause hand neurological symptoms, but because of the acute onset, neck symptoms are obvious, there is no supraclavicular fossa, and X-ray plain film without neck ribs visible, easy to identify, for individual identification difficulties, feasible MRI.
5. Rheumatism
Cervical rib deformities are often misdiagnosed as rheumatism due to upper extremity joint symptoms, especially in remote and rural areas. In fact, they are easily identified based on their respective characteristics.
6. Other
It should be differentiated from various diseases that cause brachial plexus and subclavian artery compression symptoms, including various vascular diseases, frozen shoulder, upper lung sulcus tumor, carpal tunnel syndrome, alcohol (alcohol) poisoning and diabetes.
