The cervical rib syndrome (Naffziger syndrome) results from the presence of an additional, more or less developed rib in the neck area. It is a special and most common case of the so-called thoracic outlet syndrome. See what manifests itself in cervical rib syndrome and how to treat it.

Cervical rib syndrome , also known asNaffziger syndrome , is a very rare symptom complex (it affects approx. 1% of the population), which consists in the presence of pathological neurological and vascular symptoms - arterial and venous - in the upper limbs. These symptoms are caused by pressure on the brachial plexus, subclavian and axillary arteries and the subclavian vein in the area of ​​their course in the thoracic opening between the cervical spine and the armpit.

Cervical Rib Syndrome: Causes

The cervical rib syndrome is a special case of the thoracic outlet syndrome (TOS) - it is an example of the cause of congenital TOS. It is an unusual developmental defect consisting in the presence of a bone process, the so-called additional rib, in a place where it shouldn't be - around the neck, specifically at the 7th cervical vertebra. It can run, for example, from the neck to the first rib. The "extra" cervical rib may vary in length - it may be fully developed and connect to the first rib to form a bone or rudimentary whole. It can also be hard (bone) or more flexible (fibrous).

Cervical rib syndrome can also have acquired causes.

The causes of acquired thoracic outlet syndrome include:

  • notorious maintenance of an incorrect body posture in which the shoulder girdle is lowered; it causes the head to be excessively protracted forward and the scapula protracted (protracted upwards);
  • trauma;
  • repeated repetition of certain movements with the use of excessive force in the upper limbs, typical e.g. for bodybuilders or people who perform monotonous hard work (miners), causes hypertrophy of the shoulder girdle muscles - these muscles can compress nerves or vessels;
  • stress;
  • in women - very abundant breasts, implantation of breast implants or mastectomy;
  • sternotomy (dissection of the sternum to gain access to the heart during cardiac surgery).

Cervical rib syndrome symptoms

The cervical rib may press against the brachial plexus (that is, the network of nerve fibers that run from the spinal cord through the neck and armpit to the upper arm), or the subclavian artery, the subclavian vein, or the axillary-clavicular vein. and thus cause neuropathic symptoms. Compression by the extra bone may cause a number of ailments, such as:

  • pain in the neck, shoulder, upper limb;
  • pain in the area where there is an extra rib;
  • paresthesias;
  • muscle atrophy or paresis of muscles innervated by nerves coming from the brachial plexus;
  • hypoaesthesia;
  • difficulties in making movements with the limb on which there is a bony process;
  • swelling and bruising of this limb, more common at night, in the morning (the position we take during sleep may intensify the symptoms);
  • thrombosis in the veins compressed by the rib;
  • aneurysms of the subclavian artery;
  • headaches;
  • weakening of the handshake, objects falling out of the hands;
  • Raynaud's phenomenon - sudden bruising of the limbs, especially in winter and with high air humidity, with increasing pain in the fingers;
  • pain when lifting hands up or sideways abduction - pain radiates along the medial part of the arm and forearm to the 4th and 5th fingers.
Worth knowing

90 percent in cases, the presence of an additional rib does not cause any symptoms. It is sometimes "discovered" on an X-ray by accident. However, a sudden weight gain or the start of intensive training, e.g. at the gym, may cause such a change in the position of the shoulder girdle that the appendix will start to "disturb" - exert pressure on e.g. a nerve or a vessel.

Diagnosis and treatment of the cervical rib syndrome

If the cervical rib syndrome is suspected, the doctor will first order diagnostic tests, such as: X-ray of the neck and chest, ultrasound, electromyography (examination of the electrical activity of the muscles and peripheral nerves), phlebography (examination consisting in visualizing the lumen of the vein). on the X-ray image after prior administration of contrast material). The patient should be examined by an orthopedist, neurosurgeon, vascular surgeon, possibly by a cardiac surgeon and thoracic surgeon. There is basically one treatment for Naffziger syndrome - it is a surgical operation that involves removing the structures that compress the vessels and nerves from a transaxillary or supraclavicular access. However, it depends on the size of the abnormal process. If it is large, it often has to be removed along with the first rib. If the extra rib is short and not developed, it can be reducedto physiotherapy and rehabilitation procedures. They are designed to raise the shoulder girdle.

Category:

Spine, bones, joints