CERVICAL RIB
SUBMITTED BY GURLEEN KAUR
BPT 3RD YEAR (PTO)
ROLLNO. 10672430904
CONTENT:
• Introduction
• Anatomy • Complications
• Etiology • Risk Factors
• Pathophysiology • Do’s and Don‘ts
• Types • Goals
• Clinical Features • Management
• Diagnosis • Preventions
INTRODUCTION
A cervical rib is an extra bone in your neck that some people have at birth.
Very few people have this rare bone and even fewer have symptoms from it.
A cervical rib can cause pain or weakness in your arm, but treatments can
help. A provider can remove a cervical rib because it doesn’t have a purpose.
It may be present on one or both sides and can vary in size from a small
fibrous band to a fully developed rib.
ANATOMY
• Normally, ribs arise from thoracic vertebrae only
• In cervical rib condition, an additional rib develops from C7
• It may attach to:
• First rib
• Sternum
• Or remain free
☆ Etiology (Causes)
• Congenital (present since birth)
• Developmental anomaly
• Genetic factors
☆ Pathophysiology
The cervical rib can compress nearby structures such as:
• Subclavian artery
• Subclavian vein
• Brachial plexus
This leads to Thoracic Outlet Syndrome (TOS).
TYPES OF CERVICAL RIB
• There are four cervical rib types:
• Type 1 is a complete rib that reaches your first rib.
• Type 2 is an incomplete rib with one end that doesn’t attach to anything.
• Type 3 is an incomplete rib that attaches to a fibrous band.
• Type 4 is a short bone that sticks out from the lowest vertebra in
your cervical spine (in your neck).
CLINICAL FEATURES
☆ Neurological Symptoms
• Pain in neck, shoulder, arm
• Numbness and tingling
• Weakness of hand muscles
☆ Vascular Symptoms
• Coldness in hand
• Weak or absent pulse
• Pallor or cyanosis
DIAGNOSIS
☆1. Clinical Examination
• Adson's Test
• Roos Test
• Wright Test
• X-ray (to confirm cervical rib)
• MRI / CT scan
• Doppler studies
☆ Complications
• Chronic pain
• Muscle weakness
• Vascular insufficiency
• Nerve damage
☆ Risk Factors
• Congenital (present since birth) • Poor posture (forward head, slouching)
• Prolonged sitting • Repetitive overhead activities
• Muscle imbalance (tight scalenes, weak shoulders)
• Neck/shoulder trauma
• Sedentary lifestyle
GOALS
☆ Short-Term Goals (Immediate / Acute Phase)
• Reduce pain and inflammation
• Decrease muscle spasm
• Relieve nerve compression
• Improve blood circulation
• Maintain pain-free range of motion (ROM)
• Educate patient about proper posture
☆ Long-Term Goals (Recovery / Chronic Phase)
• Restore full neck and shoulder mobility
• Improve muscle strength (neck & scapular muscles)
• Correct postural abnormalities
• Prevent recurrence of symptoms
• Improve functional activities (daily living tasks)
• Enhance overall quality of life
MANAGEMENT
☆ Conservative Treatment
• Postural correction
• Physiotherapy exercises
• Pain relief modalities (IFT, TENS, Ultrasound)
• ☆ Surgical Management
• Removal of cervical rib (if severe symptoms)
PHYSIOTHERAPY MANAGEMENT
Cervical rib commonly causes Thoracic Outlet Syndrome (TOS), so management focuses on pain
relief, decompression, and functional restoration.
• Phase 1: Acute Phase (Pain Relief Phase) (0-1 week)
* Goals: Reduce pain and inflammation
• Relieve nerve compression
• Relax muscle spasm
• Treatment
• 1. Electrotherapy
• TENS → for pain relief
• IFT → reduces deep pain
• Ultrasound therapy → promotes healing
[Link] / Thermotherapy
• Ice (acute pain)
• Moist heat (muscle spasm relief)
3. Postural Advice
• Avoid slouched posture
• Avoid overhead activities
• Proper neck alignment
4. Gentle Exercises
• Deep breathing exercises
• Gentle neck ROM (pain-free range)
• Phase 2: Subacute Phase (Recovery Phase) (1-3 weeks)
• Goals: Improve mobility • Reduce muscle tightness
• Begin strengthening
☆ Treatment
1. Stretching Exercises • Scalene muscles stretch
• Upper trapezius stretch • Pectoralis minor stretch
2. Mobilization
• Cervical spine mobilization •First rib mobilization (by therapist)
3. Strengthening (Mild)
Isometric neck exercises • Shoulder stabilizers activation
4. Postural Correction Training
• Chin tuck exercise • Scapular retraction
☆ Phase 3: Chronic Phase (Strengthening & Functional Phase) (3-6 weeks)
• Goals: Improve strength and endurance
• Correct posture permanently •Prevent recurrence
• Treatment
• 1. Strengthening Exercises
• Neck flexors & extensors Scapular muscles (rhomboids, trapezius)
• Shoulder girdle strengthening
2. Advanced Exercises
• Resistance band exercises • Functional training
3. Postural Training
• Ergonomic correction • Workplace modification
4. Breathing Exercises
Diaphragmatic breathing
☆ Phase 4: Maintenance Phase (Prevention Phase) (6 weeks onwards)
• Goals: Prevent recurrence
• Maintain function
* Management
• Regular exercise program
• Posture awareness
• Avoid heavy lifting and prolonged overhead work
• Lifestyle modification
☆ Important Precautions
• Avoid excessive neck extension
• Avoid heavy lifting
• Stop exercise if pain or numbness increases
• Monitor vascular symptoms (pulse changes)