Cervical rib

  • Cervical rib
    • additional rib which arises from the 7th cervical vertebra (MCQ)
    • It is usually attached to the first rib close to the insertion of the scalenus anterior muscle(MCQ)
    • It is more often present posteriorly for a short distance only; the anterior part being just a fibrous band.
    • The cervical rib is usually unilateral
    • It is more common on the right side.(MCQ)
  • Clinical features
    • In 90 per cent of cases, there are no symptoms (MCQ)
    • an extra rib is detected on an X-ray made for some other purpose.
    • produces symptoms after the age of 30 years,
    • It is more often symptomatic in females
    • Neurological symptoms:
      • Tingling and numb ness along medial border of the forearm and hand  (T1 dermatome) –most common presenting feature(MCQ)
      • weakness and wasting of the hand muscles
      • clumsiness in the use of the hand.
    • Vascular symptoms:
      • Compression of the subclavian artery may result in an aneurysm distal to constriction.
      • History of pain in the upper limb on using the arm or elevating the hand (claudication).
  • Differential diagnosis
    • Carpal tunnel syndrome (MCQ)
      • The symptoms are in the median nerve distribution.
      • Nocturnal pain is characteristic.
    • Cervical spine lesions (MCQ)
      • pain radiates to the outer side of the arm and forearm.
  • Treatment 
    • Conservative treatment
    • ‘shrugging the shoulder’exercises to build up the muscles
    • avoidance of carrying heavy objects like shopping bag, bucket full of water, suitcase etc.


Cervical ribs
Cervical ribs
Cervical ribs and the transverse process of the cervical vertebra.
In thoracic outlet syndrome there is compression of the brachial plexus or subclavian vessels in their passage from the cervical and upper thoracic area

Orthopedic Tests Quiz
Cervical Rib.mp4
Management of Thoracic Outlet Syndrome and Cervical Rib Removal & Scalenectomy
Young patients with Thoracic outlet Syndrome and cervical rib always presents with neurovascular symptoms and signs. The corner stone in management is Anterior scalenectomy and excision of the cervical rib from supra clavicular approach. The post stenotic dilatation from the compression of the thoracic outlet that is usually found in subclavian artery will correct itself over time
10.2.2. Cervical Rib – X-ray Reading – Dr. Vaidya
The Art of X-Ray Reading
by Dr. Ghanashyam Vaidya
Orthopedic exam: Thoracic Outlet Syndrome
Start – Observation, Palpation of Scalenes or Cervical Rib
1:04 – Adson’s Test
2:14 – Reverse Adson’s Test
2:36 – Wright’s Test
2:58 – Eden’s Test
3:30 – Roo’s Test
H & N 2 (cervical rib +TOS+cystic hygroma+pharngeal pouch)