This document discusses cervical rib, including its structure, symptoms, diagnosis, treatment options, and physiotherapy management. Cervical rib is an extra rib that grows from the base of the neck above the collarbone. It can compress nearby blood vessels and nerves, causing pain, numbness, and reduced circulation in the arm. Diagnosis involves imaging tests and physical exams like Adson's test. Treatment may include anti-inflammatory drugs, surgery to remove the rib, or physiotherapy focused on exercises to improve strength and mobility.

1. Presented by – Nikhil Govind
Moderated by – vijay Samuel Raj

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3. Introduction
Structure and function
symptoms
Diagnosis
Differential diagnosis
Medical management
Surgical management
Physiotherapy management
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4. Cervical rib also known as "neck rib" in
cervical region“and is an extra rib
which grows from the base of the neck just
above the collarbone.
 It is a congenital overdevelopment of
transverse process of cervical spine
vertebra
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5.  It can be on right, left or both sides and
may be floating with no connection
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6. the cervical rib consists of a head, neck,
and tubercle.
t is attached posteriorly to the first rib by a
fibrous band near in the insertion of the
anterior scalene muscle
 Cervical rib has no physiological function
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7. There are four types of cervical ribs:
Type 1: Complete rib that articulates with
the first rib or manubrium
Type 2: Incomplete rib with a free distal tip
Type 3: Incomplete rib with a distal fibrous
band attachment
Type 4: Short piece of bone extending
beyond the C7 transverse process
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8. Local Symptoms
Tender supraclavicular lump which is bony
hard and is fixed when palpated.
Sensory Symptoms
Tingling in hands or fingers; confined either
to radial side or ulnar side or sometimes
involve even whole hand.
Pain which may radiate down the arm.
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9.  Vascular symptoms
 Cold and clumsy extremities, particularly the
fingers.
 Skin colour changes to blue associated with
trophic changes.
 There is rare risk of gangrene.
 Radial pulse becomes feeble or may even be
absent.
 Motor Symptoms
 Loss of hand grip.
 Tendency of dropping things from the hand.
 Wasting of palmar muscles
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10. Imaging
Special tests
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12. Adson's test is a provocative test
for Thoracic Outlet
Syndrome accompanied by compression
of the Subclavian artery by a cervical rib
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13. Starting Position
The test can be performed with the patient
in either sitting or standing with
their elbow in full extension
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14.  Procedure
 • The arm of the standing (or seated) patient is
abducted 30 degrees at the shoulder and maximally
extended.
 • The radial pulse is palpated and the examiner grasps
the patient's wrist.
 • The patient then extends the neck and turns the head
toward the symptomatic shoulder and is asked to take
a deep breath and hold it.
 • The quality of the radial pulse is evaluated in
comparison to the pulse taken while the arm is resting
at the patient's side.
 • Some clinicians have patients turn their head away
from the side tested in a modified test.
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15. Positive Test
The test is positive if there is a marked
decrease, or disappearance, of the radial
pulse. It is important to check the patient's
radial pulse on the other arm to recognize
the patient's normal pulse.
A positive test should be compared with
the non-symptomatic side
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16. Shoulder Abduction test: It is
an orthopaedic test used to diagnose a
cervical nerve root injury or cervical disc
herniation. It is performed by having the
patient abduct their shoulder and place
their hand on top of their head. A positive
test will involve a decrease in
radiculopathy or pain.
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17. Herniated cervical disk
Cervical spondylosis
Peripheral neuropathies
Raynaud's disease
Syringomyelia
Polio
Muscular dystrophy
Motor neuron disease
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18. Medical Management
 Surgical Management
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19. Anti-inflammatory drugs
Analgesics
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20. Removal of extra segment.
Complete resection of the rib.
Dividing the scalene group of muscles.
Resection of cervical ribs for thoracic outlet
syndrome.
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21.  Pain relief: Short wave diathermy is used but it is
contraindicated in case of sensory impairments.
 To improve distal circulation: Gripping exercise.
 Strengthening exercises of whole arm to improve
tone, power and endurance.
 Posture Correction.
 Specific exercises like Self resisted scapular
elevation and adduction.
 Endurance training.
 Progressive resistance exercises for shoulder
girdle muscles
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23. Physiopedia
Jayanth joshi
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