Complications of surgery for thoracic outlet syndrome
Sachinder Singh Hans, Mark F. Conrad in Vascular and Endovascular Complications, 2021
There remains some room for debate regarding the necessity for first rib resection during supraclavicular thoracic outlet decompression, with some advocating for routine first rib resection and others for a more selective approach based on intraoperative findings following scalenectomy and brachial plexus neurolysis alone.40 However, it remains unclear if there are any advantages to retaining the first rib, and incomplete first rib resection is often a factor contributing to recurrent neurogenic TOS.34–39 It is therefore recommended that first rib resection always be included in supraclavicular decompression for neurogenic TOS, extending posteriorly as far as the level of the T1 nerve root and anteriorly to the costochondral junction (just medial to the scalene tubercle) (Figure 28.5). The first rib is often abnormal in patients with a cervical rib, and may serve as a source of persistent/recurrent nerve compression after isolated cervical rib resection. Thus, first rib resection is also advocated in patients with cervical ribs, along with resection of the cervical rib, in order to ensure the most complete decompression feasible.41
Extended matching item (EMI)
Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon in Radiology for Undergraduate Finals and Foundation Years, 2018
Cervical ribs are congenital supernummery ribs arising from the seventh cervical vertebra. They are hypoplastic (‘thinner’) than normal ribs and can be seen as originating from the cervical vertebrae as these transverse processes are angled inferiorly (the transverse processes of thoracic vertebrae are angled upwards). Cervical ribs are associated with Klippel-Feil syndrome, overall the prevalence of a unilateral cervical rib is 0.2%, bilateral ribs are much rarer. They can result in morbidity by trapping structures between the cervical rib and scalenus muscle, examples include thoracic outlet syndrome, brachial plexus syndrome, or subclavian artery compression.
Respiratory system
Aida Lai in Essential Concepts in Anatomy and Pathology for Undergraduate Revision, 2018
Cervical ribs Fibrous band from C7 post. to rib 1 ant.(Neurological deficit) structures passing over rib 1 elevated → causes thoracic outlet syndrome(Vascular insufficiency) subclavian a. may be narrowed → post-stenotic dilatation → thrombus formation → emboli → acute ischaemiaAnterior ramus of T1 stressed → weakness and wasting of thenar muscles
MR neurography of the brachial plexus in adult and pediatric age groups: evolution, recent advances, and future directions
Published in Expert Review of Medical Devices, 2020
Alexander T. Mazal, Ali Faramarzalian, Jonathan D. Samet, Kevin Gill, Jonathan Cheng, Avneesh Chhabra
Bony abnormalities, such as cervical ribs or prominent C7 transverse processes, can also dispose to the development of TOS, although it is hypothesized that a superimposed regional injury must generally occur to precipitate symptoms (Figure 8). Indeed, in a study performed by Sanders and Hammond, neck trauma was the cause of neurogenic symptoms among 80% of patients with cervical or anomalous first ribs [80]. MRN can be used to identify nerve signal abnormalities in the setting of TOS, which manifest as regions of T2 signal hyperintensity, often in the lower trunk, with or without associated nerve enlargement [18]. Among conventional MRN sequences, Sagittal STIR (2D and 3D reconstruction) and axial T1 images are most useful for the evaluation of anatomic neurogenic compression.
An unusual cause of “traumatic” hemothorax: perforation of the lung parenchyma by a bifid rib
Published in Acta Chirurgica Belgica, 2020
Sander Ovaere, Anneleen Peeters, Lieven Depypere
Congenital anomalies of the ribs are relatively common, and they can be divided in numerical (for example cervical ribs) or structural abnormalities (for example bifid ribs) [1]. These anomalies are usually asymptomatic. Literature on symptomatic bifid ribs is limited [2–4]. Kamano and colleagues proposed a classification for intrathoracic bifid ribs in their review paper, with these images complying with a type two Kamano intrathoracic bifid rib [2]. The images of this case illustrate the unusual traumatic perforation of the lung caused by a bifid rib. The case illustrates that one might consider resection of an asymptomatic bifid rib when imaging suggests significant compression on the lung parenchyma.
A multimodal physical therapy approach utilizing the Maitland concept in the management of a patient with cervical and lumbar radiculitis and Ehlers–Danlos syndrome-hypermobility type: A case report
Published in Physiotherapy Theory and Practice, 2018
At the time of evaluation, MRIs of the cervical, thoracic, and lumbar areas of the spine revealed disc bulging at C5-6, mild disc bulging C6-7 with neural foramina narrowing, bilateral small cervical ribs at C7, minor mid-thoracic bulge with no evidence of cord compression, and L5–S1 degenerative disc with bilateral neural foramina narrowing.
Related Knowledge Centers
- Birth Defect
- Cervical Vertebrae
- Ossification
- Supernumerary Body Part
- Rib
- Incidental Imaging Finding
- X-Ray
- CT Scan
- Thoracic Outlet Syndrome
- Nerve