II. Epidemiology

  1. Most common neurovascular compression at neck base

III. Anatomy

  1. Cervical rib (extra rib) arises from C7 Vertebra
  2. Rib narrows interval between scalenes
    1. Higher barrier for nerves and vessels to pass over
    2. Compression Worsened by
      1. Shoulder sag (in elderly or Muscle Weakness)
      2. Carrying heavy object in hand
  3. Levels C8 to T1 most commonly affected

IV. Symptoms

  1. Affects hand and inner Forearm
  2. Pain and Paresthesia along Ulnar Nerve course
  3. Hand weakness, numbness, and clumsiness
  4. Associated symptoms may be variably present
    1. Hand cold Sensation
    2. Raynaud's Phenomenon
    3. Gangrene

V. Sign

  1. Palpable cervical rib
  2. Tender Brachial Plexus distribution
  3. Muscle Weakness and atrophy (lower trunk)
    1. Interosseus Muscles
    2. Hypothenar Muscles
  4. Sensation decreased
    1. Ulnar Forearm
    2. Arm
    3. Ulnar 1.5 fingers
  5. Circulatory insufficiency
    1. Swelling
    2. Cold Sensation
    3. Distal Cyanosis
    4. Trophic skin change
  6. Adson's Test

VI. Diagnostics

  1. Chest XRay
    1. Extra rib at C7 Vertebra (Often bilateral)
  2. Electromyogram

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