Operation for Cervical Rib

Operation for Cervical Rib is done to treat thoracic outlet syndrome which can cause neck pain, numbness in the arm and other symptoms.

May 24, 2022

Operation for Cervical Rib is done to treat thoracic outlet syndrome which can cause neck pain, numbness in the arm and other symptoms.

Some facts about Cervical Rib:

  • Cervical rib is an extra rib which connects to the seventh cervical vertebra in your neck at the back.
  • The compression of the nerves, arteries, and veins that pass through the thoracic outlet, by the bones and/or muscles is known as Thoracic outlet syndrome which may cause neurogenic, venous or arterial problems.
  • Thoracic outlet syndrome may occur due to a cervical rib, trauma, a fibrous band, anatomical variability, or muscle hypertrophy.
  • Removal of a cervical rib or even the first rib is involved in the surgery.
  • Pain in your neck and shoulder which spreads into your arm is the symptom of thoracic outlet syndrome.
  • Symptoms may also include temporary loss of feeling, weakness or tingling in the affected arm and fingers, temporary inability to carry out fine hand movements, Raynaud's phenomenon, blood clot that forms in the subclavian artery and swelling in the affected arm.
  • A non-steroidal anti-inflammatory drug (NSAID), such as naproxen or diclofenac can be prescribed t non-steroidal anti-inflammatory drug (NSAID), such as naproxen or diclofenac.
  • Thoracic outlet syndrome can be developed in people with a poor posture and 'droopy' shoulders.
  • The chance of nerve or blood vessel compression between the rib or its muscles and ligamentous connections sharing this small space increases by having a cervical rib.

Diagnosis of Cervical Rib:

  • Evaluation begins with complete medical history and review of symptoms
  • You may be asked to move your arms and shoulders into certain positions when your doctor examine you
  • A chest X-ray and X-ray of your neck can be done to show if you have a cervical rib. 
  • MRI scan or CT scan of your neck and upper chest area should be done to help rule out other causes for your symptoms.
  • Nerve conduction studies may sometimes be suggested to look at the electrical activity of your nerves. This can help to show which nerves are being compressed.

Procedure for Cervical Rib Surgery:

  • Surgery is usually recommended for arterial TOS which may involve removing both the scalene muscles in the neck, the cervical rib if present and the first rib.
  • A transaxillary approach is preferred for the removal of most cervical ribs and first ribs.
  • Cervical ribs causing clinical symptoms are often fused to the first rib, and can result in aneurysm formation or thrombosis.
  • Both the cervical rib and the first rib must be removed to get relief from arterial compression.
  • An arterial reconstruction require resection of the artery from a supraclavicular approach for patients with aneurysms. 
  • The omohyoid muscle and lateral portion of the sternocleidomastoid will be identified first and then the phrenic nerve is seen on the anterior surface of the scalene muscle under them.
  • The brachial plexus is carefully retracted to reveal the cervical rib posteriorly after identifying the subclavian artery and brachial plexus.
  • A bone rongeur will be used to transect the cervical rib. 
  • Resection of cervical ribs and/or first ribs can be performed safely through a supraclavicular, transaxillary,  posterior, transthoracic, or robotic approach.