Cervical rib syndrome is one of the bottleneck syndromes. It is also known as scalenus syndrome.
What is cervical rib syndrome?
In medicine, cervical rib syndrome is also known as scalenus syndrome or Naffziger syndrome. What is meant by this is thoracic-outlet syndrome (TOS). Cervical rib syndrome represents a narrowing syndrome. It forms due to compression of nerves and blood vessels in the scalenus gap. In this case, the brachial plexus (brachial plexus) is pinched within the scalenus gap between the scalenus medius muscle as well as the scalenus anterior muscle. Cervical rib syndrome is also one of the nerve compression syndromes. In modern times, medicine groups cervical rib syndrome under the comprehensive name of thoracic-outlet syndrome. This is characterized by neurovascular compression syndromes that occur in the upper chest (thorax). The frequency with which cervical rib syndrome occurs could not be determined.
Causes
Responsible for cervical rib syndrome is compression of the brachial plexus and the subclavian artery. Both structures are located within the so-called scalenus gap. The compression may be triggered by a cervical rib, hypertrophy of scalenus muscles, or interfering ligamentous structures. The nerve plexus of the affected arm takes its course down the arms over the shoulders to the chest. Between the ribs and cervical vertebrae is the scalenus gap, which houses the scalenus medius muscle and the scalenus anterior muscle. This location can become a bottleneck if a second cervical rib is located there. Thus, excess cervical ribs are among the most common originators of cervical rib syndrome. In addition to bony structures, however, muscles in which hypertrophy occurs are sometimes responsible for the occurrence of cervical rib syndrome. Thus, the onset of muscle tissue hypertrophy causes a narrowing of the brachial plexus. In some cases, cervical rib syndrome occurs due to exostosis or steepness of the upper ribs. In this process, not only can the brachial plexus cords be affected by compression, but also the subclavian artery cords.
Symptoms, complaints, and signs
Typical symptoms of cervical rib syndrome include neuralgiform pain that occurs in the arm and shoulder. The ulnar side of the lower arm is particularly affected. The triggering cause is thought to be motor innervation of the brachial plexus of shoulder muscles and pectoral muscles. The brachial plexus also participates in the sensory and motor innervation of the hand and arm. Since the compression leads to disturbances of the sensitive hand innervation, paresthesias and hypesthesias of the hand also appear. These are sensory disturbances associated with circulatory disturbances. This is especially true when the subclavian artery is also affected by nerve compression. The disorder becomes noticeable by the frequent falling asleep of the arm. It is not uncommon for affected individuals to suffer from feelings of heaviness and numbness. Some patients complain of paralysis of the chest and arm muscles in the further course, which is due to the motor innervation of the brachial plexus in this region of the body. Also possible in the advanced stage of cervical rib syndrome are small blood clots due to narrowing of the subclavian artery. Due to these, there is a risk of occlusion of the finger vessels, causing discoloration of the fingers.
Diagnosis and course
If cervical rib syndrome is suspected, a visit to a physician is recommended. Based on the typical symptoms of the syndrome, the physician will perform various tests. For example, in scalene syndrome, the wrist pulse can no longer be felt when the head is stretched in the posterior direction, the patient turns to the painful side and inhales at the same time. This tension results in the thickening of the scalenus muscles. Using the stethoscope, the physician listens to the clavicle and perceives a murmur. This is considered an indication of arterial stenosis. X-rays are also important in cervical rib syndrome. This allows additional cervical ribs to be identified on the images. The excess cervical rib exerts pressure in cervical rib syndrome. Furthermore, thickening or changes in the shape of the first rib can be seen on the X-rays.The exact location where narrowing of the blood vessels occurs due to the syndrome can be revealed with sonography (ultrasound examination). Differential diagnosis is also important because cervical rib syndrome must be differentiated from other thoracic outlet syndromes. In principle, there is a favorable prognosis in cervical rib or scalene syndrome. Thus, complete recovery is possible in most cases.
Complications
In cervical rib syndrome, the patient primarily experiences severe pain. This pain occurs mainly in the area of the arms and shoulders and not infrequently leads to restricted movement or other limitations in everyday life. The pain can also occur in the form of pain at rest and can also bother the patient at night. This can lead to sleep disturbances and a general irritability of the patient. It is not uncommon for the pain to spread to other regions of the body. Furthermore, there are sensory disturbances and circulatory disturbances. The typical tingling sensation occurs, and the extremities may show slight paralysis. In severe cases, severe paralysis and sensory disturbances occur. Due to the paralyses, the patient’s actions are extremely limited and the quality of life is considerably reduced. Furthermore, occlusion of the blood vessels in the fingers can occur. Treatment is either by surgical intervention or with the help of medication. However, it is not possible to predict the course of the disease, as this usually depends on the severity of the cervical rib syndrome. Life expectancy is not reduced by the syndrome. However, it may not be possible to completely remove certain paralyses and disorders, so the patient will suffer from them throughout his or her life.
When should you see a doctor?
In the case of cervical rib syndrome, a visit to a doctor is necessary in any case. If the symptoms of the syndrome are ignored, it can lead to permanent paralysis or numbness that can no longer be treated. As a rule, the doctor should be consulted if there is pain in the arm or shoulder without any particular reason. Reduced motor ability of the arm may also indicate cervical rib syndrome. Furthermore, sensory disturbances or disturbances in blood flow also represent a common symptom of this syndrome. Especially constant tingling in the affected region may indicate the syndrome and should be investigated. A doctor should be consulted at the latest in case of permanent numbness. Discoloration of the fingers may also indicate the condition. Cervical rib syndrome can usually be diagnosed by an orthopedic surgeon or a general practitioner. However, treatment takes place with the help of various exercises and therapies. Whether a complete recovery will occur cannot be universally predicted. Early diagnosis always has a positive effect on the course of the disease.
Treatment and therapy
Elaborate therapy is not always required for cervical rib syndrome. Thus, in mild courses, treating the pain is usually sufficient. For this purpose, local anesthetics are applied to the affected scalenus muscles. It is also important that the patient avoids movements or stresses that trigger pain or exacerbate it. In this way, the administration of analgesics can be reduced. In some cases, treatment of neurological complaints such as paralysis may also be necessary. Such treatment should be given in time to prevent permanent damage to the affected nerve plexus. If the neurological deficits of cervical rib syndrome are severe, surgical intervention is often required. This involves removing the affected cervical rib, which exerts pressure on the brachial plexus. In this way, the main cause of the compression can be eliminated.
Outlook and prognosis
The prognosis of cervical rib syndrome is considered favorable. In a large number of cases, a few treatment steps result in significant relief of symptoms. Often, freedom from symptoms is seen within a few days. Side effects and risks can occur with drug therapy. In addition to intolerances, other complaints may develop. With the discontinuation of the medication, a spontaneous healing occurs, since the active substances are completely removed from the organism within a short time.If, despite the symptoms, the body continues to be subjected to severe stress, complications may arise. In severe cases, there is a risk of permanent damage to the skeletal, muscular or nervous systems. Therefore, adequate rest and recuperation during the healing process is necessary for a good prognosis. Subsequently, reloading should be gradual to avoid overstraining. If surgery is performed, complications may also occur. Although it is a routine procedure, there are potential risks with any surgery. If the procedure takes place successfully, the patient will quickly experience an improvement in their health. If cervical rib syndrome develops again during life, the prognosis is also favorable. Nevertheless, it should be taken into account that overall skeletal instability occurs with increasing age and is exacerbated when a cervical rib is removed.
Prevention
Effective measures to prevent cervical rib syndrome do not exist. Thus, the condition is mostly caused by excess cervical ribs. However, these are already congenital. It is at least possible to prevent the pain of cervical rib syndrome by the patient refraining from pain-triggering stress.
Aftercare
In cervical rib syndrome, first and foremost, early detection of this disease is very important. Only early detection can prevent further complications. The affected person should see a doctor at the first symptoms and signs of the disease, so that further complaints can be prevented. The focus is therefore on a quick diagnosis, although the measures and options for follow-up care are severely limited in the case of cervical rib syndrome. With the help of medication, the symptoms can be reduced. The affected person should always take the medication according to the doctor’s instructions and also observe the correct dosage. High levels of physical exertion should also be avoided so as not to strain the muscles unnecessarily. The affected person should also avoid stressful activities and rest frequently. It is not uncommon for the help and support of friends or the patient’s own family to be necessary in order to relieve the patient in everyday life. However, in some cases of cervical rib syndrome, surgical intervention is also necessary to relieve the symptoms. After such an operation, the affected person should also rest and keep bed rest. The measures of a physiotherapy can also alleviate the discomfort in this case, although many exercises from such a therapy can also be performed at home.
What you can do yourself
Mild cervical rib syndrome can be treated with the help of painkillers. This therapy can be supported by resting the arm and shoulder until the symptoms have subsided. Exercises from physiotherapy as well as sporting activities help against the circulatory disturbances. In consultation with the doctor, alternative measures such as acupuncture, massages or methods from Chinese medicine are also possible. The prescribed painkillers can also be supported by alternative means under certain circumstances. The South African devil’s claw, for example, helps with pain and relieves inflammation. Willow bark and curcumin have a similar effect. Accompanying this, any neurological complaints must be treated. Paralysis can be reduced by physiotherapeutic measures. Therapy can be supported at home by gymnastic exercises and yoga. In the case of severe neurological damage, surgery is necessary. Then, sparing and bed rest are the most effective support. The area around the surgery must be checked regularly by a doctor. If symptoms reappear after recovery, it is best to talk to the doctor in charge. In the event of major complications, such as acute pain or movement disorders, the emergency medical service is the right contact.
