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    Thoracic Inlet Syndrome and Cervical Rib

    Uploaded by

    Rabin Das
    1) Thoracic inlet syndrome occurs when the brachial plexus and subclavian vessels are compressed as they pass from the neck to the arm. It can be caused by dynamic factors like arm positioning or static factors like muscle bulk. 2) A cervical rib, which arises from the 7th cervical vertebra, is a congenital factor that can compress the brachial plexus and subclavian vessels. Symptoms include numbness and pain in the arm. 3) Treatment involves conservative measures like posture changes and exercises initially. Surgery to remove the first rib and any cervical rib may be needed in some cases to decompress the affected structures.

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    Thoracic Inlet Syndrome and Cervical Rib

    Uploaded by

    Rabin Das
    765 views28 pages
    1) Thoracic inlet syndrome occurs when the brachial plexus and subclavian vessels are compressed as they pass from the neck to the arm. It can be caused by dynamic factors like arm positioning or static factors like muscle bulk. 2) A cervical rib, which arises from the 7th cervical vertebra, is a congenital factor that can compress the brachial plexus and subclavian vessels. Symptoms include numbness and pain in the arm. 3) Treatment involves conservative measures like posture changes and exercises initially. Surgery to remove the first rib and any cervical rib may be needed in some cases to decompress the affected structures.

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    Thoracic Inlet Syndrome and Cervical Rib

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    1) Thoracic inlet syndrome occurs when the brachial plexus and subclavian vessels are compressed as they pass from the neck to the arm. It can be caused by dynamic factors like arm positioning or static factors like muscle bulk. 2) A cervical rib, which arises from the 7th cervical vertebra, is a congenital factor that can compress the brachial plexus and subclavian vessels. Symptoms include numbness and pain in the arm. 3) Treatment involves conservative measures like posture changes and exercises initially. Surgery to remove the first rib and any cervical rib may be needed in some cases to decompress the affected structures.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    765 views28 pages

    Thoracic Inlet Syndrome and Cervical Rib

    Uploaded by

    Rabin Das
    1) Thoracic inlet syndrome occurs when the brachial plexus and subclavian vessels are compressed as they pass from the neck to the arm. It can be caused by dynamic factors like arm positioning or static factors like muscle bulk. 2) A cervical rib, which arises from the 7th cervical vertebra, is a congenital factor that can compress the brachial plexus and subclavian vessels. Symptoms include numbness and pain in the arm. 3) Treatment involves conservative measures like posture changes and exercises initially. Surgery to remove the first rib and any cervical rib may be needed in some cases to decompress the affected structures.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 28

    Thoracic inlet syndrome

    and cervical rib


    By Kushal Hippalgaonkar

    THORACIC INLET SYNDROME

    INTRODUCTION
    It is the compression of subclavian
    and axillary vessels and trunks of
    brachial plexus as they pass from
    the neck to the arm

    CAUSES
    1. DYNAMIC FACTORS
    Arm in hyperabduction
    Axillary artery bent at 180 degrees , pulling
    it across the coracoid

    Compression of axillary artery

    2. STATIC FACTORS
    A) Increased muscle bulk
    Less space
    compression
    B) Inactive middle aged adults(decreased bulk)
    sagging shoulders
    angulation and compression of structures

    3.CONGENITAL FACTORS
    - Cervical rib
    4. ATHEROSCLEROTIC FACTORS
    Unusual vigorous activity in such people
    Further narrowing of structures
    5.TRAUMATIC FACTORS
    -fracture clavicle
    6. MISCELLANEOUS FACTORS
    - Tumours of upper lobe
    - Cervicothoracic scoliosis
    - Anatomical variations in scalene muscle insertion

    CLINICAL PICTURE

    NEUROLOGIC
    VASCULAR

    NEUROLOGIC SYMTOMS
    - Lower part of brachial plexus affected most
    because it overlies the first rib
    Therefore sensory impairment of C8 and T1
    Medial aspect of the arm , forearm and hand .
    - Numbness , tingling and pain (intermittent and
    burning)
    - Objective signs of neuro deficit are uncommon

    VASCULAR SYMPTOMS
    -Coldness of fingers
    -intolerance to cold
    -pallor and cyanosis of fingers
    -raynauds phenomenon in 1/4th
    patients

    Impaired blood flow may not be


    evident unless some maneuvers are
    performed , which will worsen the
    flow and cause temporary pallor .
    They are :

    1. Intermittent claudication test :


    - both arms are elevated in abducted
    and
    externally rotated
    position
    - Fingers are flexed rapidly
    - Normally 1 minute ( pt can do this )
    - Thoracic inlet syndrome within
    seconds (arm collapses

    2. Costoclavicular manuever
    - Patient sits with hands on thigh
    - Asked to throw shoulders downwards
    and backwards
    - Radial pulse is felt and supra and
    infraclavicular regions are
    auscultated .
    - Positve test absence of pulse +
    bruit on auscultation

    COMPLICATIONS

    Post stenotic dilation of vessel


    Thrombus formation in this area
    Embolus to distal vessels
    Sometimes ulceration and gangrene

    INVESTIGATIONS
    1. X-ray cervical rib , malunited
    fracture clavicle , anuerysmal
    shadow ,
    2. Arteriography stenosis ,
    aneurysmal dilation , emboli
    3. Nerve conduction studies slowing
    of conduction in affected nerve .

    TREATMENT
    1. CONSERVATIVE
    - Effective in majority .
    - Avoid injurious positions during
    working or sleeping which aggravate
    the condition
    - Postural positions avoiding the
    shoulders to droop down
    - Therapeutic exercises

    2. SURGICAL
    Small percentage cases decompression
    Principle remove 1st thoracic rib and if
    present , the cervical rib and arterial
    reconstruction
    Three approaches :
    a) Posterior approach
    b) Transaxillary approach
    c) Anterior approach

    Cervical rib
    INTRODUCTION
    It is a supernumerary rib that usually
    arises from the 7th cervical vertebra .
    Frequently bilateral .

    DEVELOPMENTAL ANATOMY
    In the embryo , nerves are much larger in proportion to ribs than in adults .
    Larger the nerve , more is the interference with development of costal
    process .
    2 types of brachial plexus :
    1. prefixed well developed 4 th cervical root and poorly developed 1 st thoracic
    root .
    Therefore , a costal recess develops from this 1 st thoracic root . This is the
    cervical rib
    Extends from transverse process of 7 th rib , varying in size from rudimentary to
    complete ( extending upto sternum).
    When rib is underdeveloped , a fibrous band extends from rib to end on scalene
    tubercle on 1st thoracic rib .
    2. postfixed well developed 1st thoracic and poorly developed 4th cervical root
    . Therefore no cervical rib formation

    PATHOLOGICAL ANATOMY
    Due to presence of complete cervical rib or
    fibrous band
    Brachial plexus and subclavian vessels must
    pass over a higher barrier before passing
    down into arm
    So compression of these structures
    ( especially lower trunk of plexus (ulnar
    nerve affection))

    CLINICAL PICTURE AND


    INVESTIGATIOONS
    Similar to thoracic inlet syndrome
    features( already discussed)
    Special findings are :
    On palpation , bony prominence of
    cervical rib felt at base of neck
    ON XRAY , cervical rib seen extending
    from 7th cervical vertebra transverse
    process .

    TREATMENT
    CONSERVATIVE
    For mild symptoms exercises to increase
    the tone of trapezius and levator scapulae .
    Arm rested in elevated state to relieve
    compression
    SURGICAL
    When symptoms are severe , the rib is
    resected .

    THANK YOU .

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