Neck rib syndrome is one of the bottleneck syndromes. It is also known as scalene syndrome.
What is cervical rib syndrome?
In medicine, cervical rib syndrome is also known as scalene syndrome or Naffziger syndrome. This means thoracic outlet syndrome (TOS). Neck rib syndrome is a bottleneck syndrome. It is caused by compression of nerves and blood vessels in the scalene gap.
The brachial plexus (arm braid) is clamped within the scalenus gap between the musculus scalenus medius and the musculus scalenus anterior. Neck rib syndrome is also one of the nerve compression syndromes. Today, medicine summarizes the cervical rib syndrome under the comprehensive term thoracic outlet syndrome.
This is characterized by neurovascular compression syndromes that occur in the upper chest (thorax). It was not possible to determine the frequency with which cervical rib syndrome occurs.
Compression of the brachial plexus and the subclavian artery is responsible for the cervical rib syndrome. Both structures are located within the so-called scale gap. Compression can be triggered by a cervical rib, scalene muscle hypertrophy, or disruptive ligament structures.
The network of nerves in the affected arm runs along the arms over the shoulders to the chest. Between the ribs and cervical vertebrae is the scalenus gap, which houses the musculus scalenus medius and the musculus scalenus anterior. This point can become a bottleneck if a second cervical rib is located there.
Excess neck ribs are among the most common causes of neck rib syndrome. In addition to bony structures, muscles that are hypertrophied are sometimes responsible for the occurrence of cervical rib syndrome. The onset of oversize muscle tissue causes a narrowing of the arm nerve network.
In some cases, cervical rib syndrome is caused by exostosis or sagging of the upper ribs. During this process, not only the cords of the brachial plexus can be affected by compression, but also the cords of the subclavian artery.
Symptoms, Ailments & 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 reason is the motor innervation of the brachial plexus of the shoulder muscles and pectoral muscles. The arm plexus is also involved in the sensory and motor innervation of the hand and arm.
Since the compression leads to disturbances in the sensory innervation of the hand, paresthesias and hypoesthesias also appear in the hand. These are sensory disturbances that are associated with circulatory disorders. This is especially true when at the same time the subclavian artery is affected by the nerve compression. The disorder becomes noticeable through the frequent falling asleep of the arm.
It is not uncommon for those affected to suffer from feelings of heaviness and numbness. Some patients later complain of paralysis of the chest and arm muscles, which can be attributed to the motor innervation of the brachial plexus in this region of the body.
Small blood clots due to narrowing of the subclavian artery are also possible in the advanced stage of cervical rib syndrome. This poses the risk that the finger vessels will become blocked, causing the fingers to become discolored.
Diagnosis & History
If you suspect cervical rib syndrome, it is advisable to see a doctor. Based on the typical symptoms of the syndrome, the doctor carries out various tests. For example, with scalene syndrome, the wrist pulse can no longer be felt when the head is stretched backwards, the patient turns to the painful side and inhales at the same time. This tension causes the scalene muscles to thicken.
The doctor listens to the collarbone with the stethoscope and hears a hissing noise. This is an indication of arterial narrowing. X-rays are also important in the case of cervical rib syndrome. In this way, additional cervical ribs can be identified in the pictures. The excess cervical rib exerts pressure in cervical rib syndrome.
Furthermore, thickening or changes in shape of the first rib can be seen on the X-ray images. The exact point at which the narrowing of the blood vessels occurs due to the syndrome can be shown with a sonography ( ultrasound examination ).
The differential diagnosis is also important because the cervical rib syndrome must be differentiated from other thoracic outlet syndromes. In principle, a cervical rib or scalene syndrome has a favorable prognosis. Complete healing is possible in most cases.
In the case of cervical rib syndrome, the patient primarily experiences severe pain. This pain occurs mainly in the arms and shoulders and often leads to restricted movement or other restrictions in everyday life. The pain can also occur in the form of rest pain and also burden the patient at night.
This can lead to sleep disorders and general irritability of the patient. It is not uncommon for the pain to spread to other regions of the body. Sensory disturbances and circulatory disorders also occur. The typical tingling occurs, whereby the extremities can show slight paralysis.
In severe cases, severe paralysis and sensory disturbances occur. The patient’s actions are extremely restricted due to the paralysis and the quality of life is significantly reduced. The blood vessels in the fingers can also become blocked. Treatment is either through surgery or with the help of medication.
However, the course of the disease cannot be predicted, as this usually depends on the severity of the cervical rib syndrome. Life expectancy is not reduced by the syndrome. However, it is possible that certain paralysis and disorders cannot be completely removed, so that the patient will suffer from them for the rest of his life.
When should you go to the 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, permanent paralysis or numbness can occur that can no longer be treated. As a rule, the doctor should be consulted if there is pain in the arm or shoulder without a specific reason.
Reduced motor ability of the arm can also indicate cervical rib syndrome. Sensory disturbances or circulatory disorders are also common symptoms of this syndrome. Constant tingling in the affected region in particular can indicate the syndrome and should be examined. At the latest in the case of permanent numbness, a doctor should be consulted. Discoloration of the fingers can also indicate the disease.
Neck rib syndrome can usually be diagnosed by an orthopedist or general practitioner. However, the treatment takes place with the help of various exercises and therapies. Complete healing cannot be universally predicted. Early diagnosis always has a positive effect on the course of the disease.
Treatment & Therapy
Complex therapy is not always necessary for cervical rib syndrome. In the case of mild courses, treating the pain is usually sufficient. For this purpose, local anesthetics are introduced into the affected scalene muscles.
It is also important that the patient avoids movements or loads that trigger or increase pain. In this way, the administration of analgesics can be reduced. In some cases, therapy for neurological complaints such as paralysis may also be necessary.
Such treatment should be carried out in good time so that there is no permanent damage to the affected nerve plexus. If the neurological deficits of the cervical rib syndrome are severe, an operation is often necessary. The affected neck rib, which exerts pressure on the arm nerve plexus, is removed. This eliminates the root cause of compression.
Outlook & Forecast
The prognosis of a cervical rib syndrome is classified as favorable. In a large number of cases, a few treatment steps lead to a significant alleviation of the symptoms. Freedom from symptoms is often noted within a few days.
Drug therapy can have side effects and risks. In addition to intolerance, other complaints can develop. Spontaneous healing occurs when the drug is discontinued, since the active ingredients are completely removed from the organism within a short time.
If, despite the symptoms, there is further heavy strain on the body, complications can arise. In severe cases there is a risk of permanent damage to the skeletal, muscular or nervous system. Sufficient rest and rest during the healing process is therefore necessary for a good prognosis. Afterwards, a new load should be carried out step by step, so that excessive demands are avoided.
If an operation is performed, complications can also occur. Although it is a routine procedure, there are potential risks with any surgery. If the procedure is successful, the patient will quickly experience an improvement in their health.
If a cervical rib syndrome develops again in the course of life, the prognosis is also favorable. Nevertheless, it should be taken into account that the skeletal system becomes unstable with increasing age and that this is exacerbated when a cervical rib is removed.
There are no effective measures to prevent neck rib syndrome. The disease is usually caused by excess neck ribs. However, these are already innate. It is at least possible to prevent the pain of cervical rib syndrome if the patient refrains from stress that causes pain.
In the case of cervical rib syndrome, early detection of this disease is very important. Early detection is the only way to prevent further complications. The affected person should consult a doctor as soon as the first symptoms and signs of the disease appear, so that further complaints can be prevented.
The focus is therefore on a quick diagnosis, although the measures and options for aftercare in the case of cervical rib syndrome are severely limited. The symptoms can be reduced with the help of medication. The affected person should always take the medication according to the doctor’s instructions and also observe the correct dosage.
High physical stress should also be avoided in order not to strain the muscles unnecessarily. The affected person should also not perform any stressful activities and rest frequently. It is not uncommon for the help and support of friends or one’s own family to be necessary in order to relieve the patient of everyday life.
However, in some cases of cervical rib syndrome, surgery is also necessary to relieve the symptoms. After such a procedure, the affected person should also rest and keep bed rest. Physiotherapy measures can also alleviate the symptoms, and many exercises from such therapy can also be carried out at home.
You can do that yourself
Mild cervical rib syndrome can be treated with painkillers. This therapy can be supported by resting the arm and shoulder until the symptoms have subsided. Physiotherapy exercises and physical activity help against circulatory disorders.
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 supplemented by alternative means under certain circumstances. The South African devil’s claw, for example, helps with pain and reduces inflammation. Willow bark and curcumin have a similar effect.
At the same time, any neurological complaints must be treated. Paralysis can be reduced by physiotherapeutic measures. The therapy can be supported at home with gymnastic exercises and yoga.
If the neurological damage is severe, an operation is necessary. Then rest and bed rest are the most effective support. The area around the procedure must be checked regularly by a doctor. If symptoms reappear after recovery, it is best to speak to the responsible doctor. In the event of major complications, such as acute pain or movement disorders, the medical emergency service is the right contact person.