Cervical Rib Complications: Thoracic Outlet Syndrome, Neurologic and Vascular Risks

A cervical rib—an extra rib arising from the seventh cervical vertebra (C7)—occurs in ~0.5–1% of the population. While often asymptomatic, it can compress neurovascular structures traversing the thoracic outlet (space between clavicle and first rib), causing cervical rib syndrome (a form of thoracic outlet syndrome).

Clinical Manifestations

Neurogenic TOS (Most Common, ~95%)

• Brachial plexus compression (lower trunk: C8–T1)
• Pain, paresthesia, numbness in ulnar distribution (medial forearm, 4th–5th digits)
• Hand weakness, thenar wasting, grip difficulty
• Symptoms worsen with arm elevation, overhead activities

Vascular TOS

• Venous (Paget-Schroetter): Subclavian vein compression → arm swelling, cyanosis, distended veins, heaviness
• Arterial: Subclavian artery compression → post-stenotic aneurysm, thromboembolism → hand ischemia, pallor, coolness, digital gangrene

Spinal Cord Compression (Rare)

• Myelopathy: gait disturbance, hyperreflexia, bowel/bladder dysfunction, sexual dysfunction

Other Symptoms

• Neck/shoulder pain, headaches, fatigue

Diagnosis and Treatment

• Imaging: CXR (cervical rib), CT/MRI angiography (vascular), EMG/NCS (neurogenic)
• Conservative: Physical therapy (scalene stretching, postural correction), NSAIDs, activity modification
• Surgical: Cervical rib resection (transaxillary or supraclavicular) ± scalenectomy for refractory neurogenic or any vascular TOS

Early diagnosis prevents permanent nerve damage or vascular complications. Consult a vascular/thoracic surgeon or neurologist if symptoms suggest TOS.