A cervical rib is an extra rib that forms above the normal first rib,
growing from the base of the neck just above the collarbone. The defect is
present at birth, but usually not noticed until later in life.
It may be a fully-formed bony rib or just a thin strand of tissue fibers,
which will not always show up on any X-ray or MRI scans you may have. If the
extra rib is only partially formed, it may either end in a swelling that shows
as a lump in the neck or it may tail off into a fibrous band of tissue that
connects to the first proper rib.
A cervical rib can sometimes squash one of the nearby blood vessels or
nerves, causing problems such as neck pain and numbness in the arm. These
symptoms are collectively known as thoracic outlet syndrome.
Thoracic Outlet Syndrome
Not all people with a cervical rib will develop thoracic outlet syndrome,
and thoracic outlet syndrome can also be caused by other conditions.
Two major blood vessels (the subclavian artery and subclavian vein) and a
bunch of nerves called the brachial plexus pass over the cervical rib. They run
through a narrow space at the base of the neck towards the armpit and arm.
A cervical rib will only cause any symptoms if it is squashing these blood
vessels or nerves.
Symptoms of Thoracic Outlet Syndrome
If the extra rib does press on a vessel or nerve, you may have any of the
in the shoulder and neck, which spreads into the arm – this may come and
go or be constant
where you lose feeling and have weakness or tingling in the affected arm
where you can’t carry out fine hand movements, such as doing up buttons
Raynaud’s phenomenon, where the blood vessels go into a temporary spasm,
affecting blood supply to the fingers and toes (turning them white)
blood clot forming in the artery supplying the hand, which can affect the
blood supply to the fingers, causing small patches of red or black
in the affected arm (although this is rare)
These symptoms vary widely from person to person: they may be mild or
severe, be persistent or come and go.
Thoracic outlet syndrome usually starts between the ages of 20 and 50 years
old, and women are more likely than men to have it.
Most people diagnosed with a cervical rib will find their symptoms get
better with time, without treatment. Your GP may refer you to a physiotherapist
for shoulder exercises designed to stretch and strengthen the neck region and
correct any poor posture. The area may be massaged to release any tight or
shortened neck tissues. A referral to an occupational therapist may also be
useful, for advice on techniques to protect your back and neck while at work.
To relieve any pain and inflammation,
your doctor may prescribe you an NSAID painkiller such as naproxen or
diclofenac. If you develop thoracic outlet syndrome you may also be prescribed
thrombolytic to break up any blood clots, and anticoagulantsto prevent further
clots developing. If the above measures don’t help and the symptoms persist,
you may wish to consider surgical treatment to remove the extra rib, although
this is often a last resort.