Congenital abnormality of cervical- thoracic spine are more cervical ribs, which can be one- or two-sided. The latter often come in different sizes and have different degrees of clinical manifestations. Despite the inherent nature, they draw attention to themselves in adulthood. At the same clinical symptoms caused by degenerative- dystrophic changes in the surrounding soft tissues.
Distinguish between true and false cervical rib. True cervical rib is the head , neck , body and is connected to the transverse process of the edge- vertebral joints . When false cervical ribs marked joint body with ribs transverse process as a syndesmosis or synostosis .
A distinction is also complete and incomplete cervical rib. Full cervical ribs resemble the present edge and localization to C7 are connected with one pectoral fin by a cord , syndesmosis or synostosis . Incomplete cervical rib loose ends in the soft tissues , and in rare cases it is connected to the end of one breast edge through the fibrous strand. Cervical ribs must be distinguished from hypertrophic transverse processes of the cervical vertebrae.
Cervical ribs are equally the same with one or both sides , more often in women than in men , about 85:15.
Cervical ribs occur relatively frequently , they are found in 0.5 % of the healthy population. They are preferably in women. Despite their inherent nature, they draw attention to themselves , causing the well -known neural and vascular symptoms only during puberty or in 20-30-40 years of age (due to overwork or traumatization of blood vessels and nerves) and only relatively rare in children age. Klinichski disease occurs at an average of 10 % of the people and with the presence of cervical ribs .
Most often, cervical rib associated with the seventh , rarely sixth cervical vertebra . They come out of the front rib tubercle of the transverse process vertebrae . In 70-80 % of all cases of cervical ribs rozvivayutsya extensions on both sides, but almost never symmetrical. Their shape and size are extremely diverse. We have to see what a very short vestige barely protruding beyond the transverse process , then tapering wedge-shaped flat or cylindrical edge length of 3-5 cm, finally , a broad well- formed edge going into a semicircle parallel to the first edge . The front end of a cervical rib is almost never comes to the sternum and not articulated with it. Usually, the front end is connected synostosis or joint with the first rib , but most of the front end extends forward band of fibrous tissue that attach to the first rib adjacent to lisfrankovym tubercle and, of course , invisible on the radiograph . It is a short rudimentary and not well-developed extra long ribs are most concerned about the patient and require surgical removal . Most cervical rib associated with spinal ankylosis .
Characterized by the appearance of patients: low drooping shoulders often yavlyayutsya a continuation shei.Eto gives them ” tyulenepodobny ” look. The edge is often possible to probe in the supraclavicular fossa.
The clinical picture of the disease is determined by the number of edges , and the length of their relationship to the neurovascular bundle . More than 90 % of patients have asymptomatic , and cervical ribs show how the find X-ray examination of patients. Sometimes in the supraclavicular area visible under the skin contoured ends of the cervical ribs . In these cases, palpable painless or mildly painful bone tumor formation consistency.
In the great majority of patients with brachial plexus and subclavian artery in the interscalene interval are free , and at least 10 % of the patients is compression of the neurovascular bundle cervical rib or fibrous tyazhem . In these cases, so-called developing compression syndrome . A secondary , but no less important role in the development of compression syndrome play hypertrophy and anterior scalene muscle spasm . Based on clinical observations revealed that at full cervical ribs predominate symptoms of circulatory disorders in the limbs due to compression of the subclavian artery , and at the edges of the parent prevails neurological symptoms . In the majority of cases encountered combination of neurological and vascular disorders.
Pain – the most characteristic and constant symptom . The pain occurs mainly after physical downloads , turning heads, necks , hands, drooping shoulders and shoulder girdle . It can be acute or local common . Pain syndrome is localized mainly in the area of ??innervation of the ulnar nerve, but sometimes extends to the shoulder girdle , the occipital region . Characterized by hypersensitivity , gipostezii , anesthesia, most pronounced in the area of ??innervation of the ulnar and radial nerves .
Circulatory disorders are associated with impaired blood flow in the subclavian artery and its branches , and can range from mild to reduce the pulse wave at the radial artery to the limb gangrene . Because of the pressure on the ribs subclavian artery can develop a variety of pathological changes . At constant pressure on the edges of the vascular wall celebrated her traumatic injury to the development of atheromatous changes in the vascular wall. Violation of the trophic vascular and organic changes are a predisposing factor for the development of the subclavian artery thrombosis . In some cases, the stimulation of the sympathetic trunk spasms occur vasa vasorum, their thrombosis, resulting in disruption of trophic vascular wall for a considerable distance and Development veretenooobraznoy aneurysm in the distal third of the subclavian artery.
When compression of the subclavian artery varying degrees of patients can not work with your hands , lift weights , drive a car. The organic change in the subclavian artery and its terminal divisions appear in the form of edema, cyanosis of the extremities , gangrene of the fingers.
Irritation stems and dysfunction of autonomic nervous system are manifested mainly vasomotor disturbances . The skin is cold , increased sweating. On the affected side is common symptom of Horner .
Adson described the test for the detection of compression of the subclavian artery. The patient sitting takes a deep breath , raised his chin and turns his head toward the lesion. Hands on her lap . Reduction of heart rate , pressure changes are pathognomonic signs of compression of the artery.
Cervical ribs and hypertrophied transverse processes may be the cause of the syndrome scalene muscle , in which there is a compression of the subclavian artery interval interscalene brachial plexus fibers autonomic nervous system going in the brachial plexus and subclavian artery located around .
Cervical ribs and hypertrophied transverse processes may be the cause of the syndrome scalene muscle at which the compression of the interscalene gap in the subclavian artery , brachial plexus , the fibers of the autonomic nervous going in the brachial plexus and subclavian artery located around .
The clinical picture is due in each case, the anatomical features additional ribs and mainly by its relation to the neurovascular bundle , which is experiencing due to the additional rib eye strain and compression . There is usually visible to the eye or swelling of bone palpated consistency is often mistaken for tumor growth . Nervous system disorders have a first violation of the sensitive nature of the sphere ( pain , cold extremities , paresthesia, sometimes itching) , and with further development – and motor disturbances of order ( the weakening of muscle strength , progressive muscle atrophy ) . Circulatory disorders are reduced mainly to compression of the subclavian artery or by the extension rib or anterior scalene muscle . As a result of weakened or even disappears completely radial pulse and venous thrombosis may occur . Sometimes children develop a stiff neck , so that all cases of torticollis should be checked radiographically.
Along with the syndrome cervical rib syndrome should be considered a high first rib or costoclavicular syndrome ( syn. : the syndrome of the upper thoracic syndrome, Faulconer – Weddell ) – narrowing the gap between the clavicle and the first rib abnormally high with a corresponding compression of the neurovascular bundle . Due to this, there is a disorder of the venous and arterial circulation .
The objective symptoms of these diseases is not very different from the symptoms of other neurovascular syndromes , and therefore the diagnosis of great importance attaches to the auxiliary methods.
The X-ray finding cervical rib and hypertrophied transverse processes , deformation of the clavicle , the first rib high ( in side view ) is determined by the increase of the arc angle of the ribs and the clavicle with respect to the horizontal and frontal planes have the scoliosis cervical and thoracic spine , tapering costoclavicular space on the respective side .
Pathognomonic and cleidocostal sample , leading to the eponymous suzheniiyu gap : the deployment and lowering the shoulders, arms and abduction causes the disappearance or weakening of the radial pulse , and by the middle of the clavicle appears systolic murmur . At the back shoulder abduction and lowering it disappears down the radial pulse , there is a feeling of numbness and acrocyanosis hands . If you decrease the space costoclavicular tip of the index finger , introduced in costoclavicular gap causes the disappearance of the pulse. When the position of the head and hands of patients the radial pulse , decreased brachial blood pressure is determined by the noise of subclavian artery , amplified the symptoms of brachial plexus compression .
In more than 90% of cervical ribs are X-ray and find a special method do not require treatment . In doubtful cases, or when a clinical syndrome of anterior scalene muscle is more conservative treatment, which includes the creation of rest the neck, shoulder girdle , upper limbs , improve blood circulation , relieve muscle spasm ladder , therapy aimed at the resolution of scar tissue . Bagopriyatny effect can be obtained from the infiltration of novocaine the insertion of anterior scalene muscle , and procaine blockade cervicothoracic ( stellate ) node.
Used for the immobilization collar trench , soft bandage for fixing the top limb. Prescribe vasodilators ( dibazol , nikoshpan , komplamin ) , physiotherapy ( elektrofarez novocaine , hyaluronidase , potassium iodide ) , massage, medical gymnastics .
In the presence of symptoms caused by compression of the neurovascular bundle cervical ribs , the effect of conservative treatment questionable .
Surgical treatment . The indications for resection of radiographically identified additional cervical rib yavlyayutsya signs of compression of the neurovascular bundle with a positive test vascular Axon . Cervical rib is removed from the front or rear access.
Postoperatively, the patient is superimposed collar trench for a period of 1-2 months.