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Case Studies | Physiotherapy | India | Volume 13 Issue 6, June 2024 | Rating: 5.5 / 10
A Case Study of Conservative Management for Cervical Rib Induced Thoracic Outlet Syndrome
Abstract: Background: Cervical ribs, commonly addressed as accessory or neck ribs, are rare congenital supernumerary ribs arising from the seventh vertebra. This anatomic variant's prevalence is believed to be underreported as only symptomatic cases are brought to attention, whether unilateral or bilateral. A gender preference is observed, with the condition being twice as prevalent in women as men. Thoracic outlet syndrome (TOS) is caused by the compression of the subclavian artery/vein and/or the brachial plexus as they traverse through the thoracic outlet. TOS development is the leading clinical picture of discovery and morbidity associated with cervical ribs; such ribs are large and frequently fused to the first rib. This placement also predisposes to aneurysm formation or thrombosis1. Cervical ribs have been associated with mutations in the HOX genes responsible for constructing axial skeleton patterns. Owing to their rarity, it has been challenging to establish a familial pattern. Cervical ribs have an estimated prevalence of 2% in the general population and 8.3% of those with thoracic outlet syndrome symptoms2. Case Presentation: 38-year-old healthy female presents with intermittent hand numbness and tingling along the C8 distribution that worsened with sewing work. She reported at times; her symptoms had gotten bad enough for her to temporarily lose sensation in her fingertips. Records review revealed an x-ray confirming cervical rib on the left side. Results: After the treatment of surrounding dysfunctions without improvement in symptoms, the cervical rib was identified, manually isolated, and treated with interferential current (lFC), moist hot pack (MHP), manual therapy and therapeutic exercise; this treatment provided immediate resolution of her symptoms. She remained asymptomatic for 10 days after treatment. A repeat treatment at two weeks resulted in resolution of her symptoms as far out as 1 month. Conclusion: At the end of two and half weeks of an outpatient physical therapy program including interferential current (lFC), moist hot pack (MHP), manual therapy and therapeutic exercise, the patient reported a significant reduction in the frequency and intensity of her symptoms as an effective option in the conservative management of thoracic outlet syndrome.
Keywords: cervical ribs, neck ribs, vertebra, thoracic outlet syndrome
Edition: Volume 13 Issue 6, June 2024,
Pages: 61 - 62