Cervical Rib Physiotherapy Treatment. A cervical rib is an uncommon congenital condition where an extra rib forms above the first rib, originating from the seventh cervical vertebra in the neck. This additional rib is present in a small percentage of the population (about 0.5% to 1%) and can exist on one or both sides of the neck (1). Although many people with a cervical rib may not experience any symptoms, it can sometimes lead to thoracic outlet syndrome (TOS). This occurs when the rib compresses nearby nerves, blood vessels, or muscles, causing discomfort.
Causes of Cervical rib
The causes of a cervical rib are primarily related to congenital factors, meaning it is present from birth due to abnormalities during fetal development. Specifically, a cervical rib forms as a result of improper segmentation of the embryonic tissue that leads to the development of vertebrae and ribs. This anomaly is a genetic variation, although the exact genetic mechanisms are not always clear. Here are some possible causes or contributing factors:
Congenital Developmental Anomaly: This anomaly occurs due to a disruption in the normal segmentation and differentiation process of the embryonic tissue that forms the vertebrae and ribs. While the exact triggers of this developmental anomaly are not fully understood, it is believed to involve both genetic and environmental factors during early fetal growth. Consequently, a cervical rib is a structural variation present from birth, which may remain asymptomatic or cause symptoms later in life if it affects surrounding nerves and blood vessels. Best Cervical Spondylosis Treatment
Genetic Predisposition: The development of a cervical rib may also be influenced by a genetic predisposition, suggesting that certain individuals are more likely to inherit the trait due to genetic factors. Although the exact genes responsible for this anomaly are not well-established, there is evidence that cervical ribs can run in families, indicating a hereditary component. Cervical ribs have been linked to other congenital abnormalities, pointing to the possibility that genetic mutations affecting embryonic development might contribute to this condition. Such predispositions may cause the improper regression of the costal element of the seventh cervical vertebra during fetal development, leading to the formation of the extra rib.
Familial Occurrence: The occurrence of a cervical rib can sometimes be traced to a familial pattern, where the condition is present in multiple members of the same family. This suggests that a hereditary component may play a role in its development. While cervical ribs are rare, they can be passed down through generations, supporting the idea that certain genetic traits may increase the likelihood of this congenital anomaly. Families with a history of cervical ribs or other related skeletal anomalies may exhibit a predisposition to improper development of the coastal elements during fetal growth.
Cervical rib types
Cervical ribs can vary in size, shape, and impact, leading to different types based on their development and how much they extend from the cervical vertebrae. These types are generally classified as:
Complete Cervical Rib: This type fully extends from the seventh cervical vertebra to the first rib or the sternum. It resembles a normal rib and may have a bony connection to the first rib. This type is more likely to cause symptoms, as it can compress surrounding nerves and blood vessels.
Incomplete Cervical Rib: In this type, the cervical rib does not fully extend but is present as a small bony projection or a fibrous band. While it may not cause significant compression on its own, it can still result in thoracic outlet syndrome if it puts pressure on nearby structures.
Unilateral Cervical Rib: A cervical rib that occurs on only one side of the neck, either the right or left side. This is more common than having ribs on both sides.
Bilateral Cervical Ribs: Cervical ribs that occur on both sides of the neck. This type may increase the likelihood of symptoms, especially if both ribs contribute to the compression of nerves or blood vessels.
Cervical rib neck pain
A cervical rib can be responsible for neck pain, especially when it leads to thoracic outlet syndrome (TOS), a condition where the extra rib compresses nearby nerves, blood vessels, or muscles. This compression can result in pain in the neck, shoulders, and arms. Neck pain caused by a cervical rib typically stems from the pressure exerted on the brachial plexus (a network of nerves that run from the spine through the neck and into the arms) or nearby blood vessels.
Patients with cervical rib-induced TOS often report neck pain, tingling, or numbness in the arms, and sometimes weakness or swelling in the affected area. Surgical intervention may be necessary to relieve symptoms if conservative treatments fail to provide relief (2).
Cervical Rib Physiotherapy Treatment
Physiotherapy is often an effective treatment for managing symptoms caused by a cervical rib, especially when it results in thoracic outlet syndrome (TOS). The goal of physiotherapy is to relieve the compression of nerves and blood vessels and improve muscle function and posture. Here are some common physiotherapy treatments for cervical rib-related issues:
Postural Training
Improving posture is crucial for reducing pressure on the brachial plexus and nearby structures. Slouching or forward head posture can worsen the symptoms. Postural exercises focus on:
- Strengthening the muscles in the upper back and shoulders
- Aligning the neck and spine properly
- Preventing forward-leaning head positions
Stretching Exercises
Stretching helps reduce tightness in the neck, shoulder, and chest muscles, particularly the scalene muscles (which are often compressed by the cervical rib). Stretching exercises may include:
- Neck stretches to relieve tension
- Shoulder and chest stretch to open the thoracic outlet
Strengthening Exercises
Strengthening the muscles around the shoulder and upper back can reduce pressure on the nerves and improve stability. Common exercises include:
- Strengthening the trapezius and rhomboid muscles
- Building core strength to support overall posture and reduce strain on the neck
Manual Therapy
Physiotherapists may use manual techniques such as soft tissue mobilization and gentle joint mobilization to release muscle tension and reduce nerve compression. These techniques can help improve mobility and decrease pain.
Various government and private hospitals, private chambers, clinics, and numerous small and large institutions provide physiotherapy or manual therapy treatment. However, for an accurate diagnosis, it is essential to consult a graduate physiotherapist. Currently, among the various physiotherapy institutions in Bangladesh, ASPC Manipulation Therapy Center (House #U64, Noorjahan Road, Mohammadpur, Dhaka-1207) is a specialized institution that offers patient services exclusively through manual therapy. They provide correction therapy based on the Structural Diagnosis & Management (SDM) technique, according to the patient’s condition, enabling patients to achieve quick and optimal recovery.
Nerve Gliding Exercises
Nerve gliding (neurodynamic) exercises are designed to mobilize the brachial plexus and help reduce nerve tension. These exercises aim to restore normal nerve movement through the thoracic outlet, reducing symptoms like tingling and pain.
Breathing Exercises
Breathing exercises can help relieve tightness in the chest and neck muscles, as improper breathing mechanics can contribute to TOS symptoms. Diaphragmatic breathing is often recommended to reduce strain on the accessory muscles of breathing (like the scalene muscles).
Ergonomic Modifications
Physiotherapists may provide recommendations on modifying your workspace or daily activities to reduce strain on your neck and shoulders. Ergonomic adjustments can help minimize the risk of further compressing the thoracic outlet.
References
- Sharma, D.K., Vishnudutt, S.V. and Rathore, M., 2014. Prevalence of ‘Cervical Rib’and its association with gender, body side, handedness and other thoracic bony anomalies in a population of Central India. Indian Journal of Basic and Applied Medical Research, 3(2), pp.593-597. https://www.ijbamr.com/assets/images/issues/pdf/593-597.pdf.pdf
- Roos, D.B., 1971. Experience with first rib resection for thoracic outlet syndrome. Annals of surgery, 173(3), pp.429-442. https://journals.lww.com/annalsofsurgery/citation/1971/03000/experience_with_first_rib_resection_for_thoracic.15.aspx
Assistant professor, Dhaka College of Physiotherapy
Chief Consultant(Ex): Popular Medical college Hospital, Dhanmondi- 2.
Chairman and Chief Consultant: ASPC Manipulation Therapy Centre, Nurjahan Road, Mohammadpur.
Founder and conceptual inventor: Structural Diagnosis and Management (SDM) concept.
Secretary: Centre for the Rehabilitation of Autism and Person with Disabilities (CARD).
Secretary-General: Bangladesh Physiotherapy Association (BPA).
Phone +88 01712-867364
Email aspc.dhaka@gmail.com
Website https://aspc.com.bd
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