cervical rib syndrome - a case report - sung soo kim, m.d. hyeong cheol ryu, m.d. department of...
TRANSCRIPT
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Cervical Rib Syndrome
- A Case Report -
Sung Soo Kim, M.D.
Hyeong Cheol Ryu, M.D.
Department of Orthopaedic Surgery, School of Medicine, Dong-A University, Busan, Korea.
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Case Report• F/16• C/C: Pain on both lateral neck esp. when raising arms• D: 2 years (1 year ago, symptoms
aggravated especially on left side and radiating pain to elbow)
• P/H: N-C
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Case Report• P/Ex:
– Palpable bony prominence on both lateral neck(esp. Lt.)
– Tenderness(+/++)– Radiating pain on arm(+/++)– Lt. 4th & 5th fingers: sensory decreased & tingling sensation– Adson test(-/+)– LOM on neck: mild– Thrill(-/-), muscle atrophy(-/-), DTR(NL/NL)
• EMG/NCV: WNL
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Roentgenograph
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3-dimensional CT
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Treatment
• Rt.: conservative Tx.• Lt.: surgery
– Supraclavicular approach– Release of ant. scalene muscle– Removal of 7th cervical rib
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Operative Findings
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Postop Roentgenograph
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Postop Care
• POD 2: intermittent shoulder exercise start• Adson test at POD 2: Lt.(-)• Sx.: radiating pain & tingling sensation -> improved• Cx.: none
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Cervical Rib Syndrome
• Scalene space, interscalene triangle– clavicle, first rib, ant. & middle scalene mu
scles• Thoracic outlet syndrome
– Cervical rib syndrome– Scalenus anticus syndrome– Costoclavicular syndrome– Hyperabduction syndrome
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Cervical Rib Syndrome
• 1740 Hunauld; first reported• 1860 Willshire, 1869 Gruber; conception for diagnosis• 1861 Coote; first surgical removal of cervical rib
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Cervical Rib Syndrome• Sx.
– Nerve compression Sx.(MC)• Traction & compression: C8, T1 nerve root(lower trunk)• Pain on neck & shoulder• Radiating pain, paresthesia & numbness: median & ulnar
nerve dermatome– Arterial compression Sx.
• Pain, claudication, pallor, Raynaud phenomenon• Peripheral embolism
– Venous compression Sx.• Coolness, duskiness, venous dilation, edema• Subclavian vein thromboembolism, peripheral necrosis
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Costoclavicular Syndrome
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Cervical Rib Syndrome
• Dx.– Adson test, Wright test and hyperabduction tes
t etc.(But positive to normal person)– Roentgenogram, CT, MRI– Angiogram, Doppler test– Myelogram– EMG/NCV
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Cervical Rib Syndrome
• Davis & King– Symptom developed third & fourth decade
• Delayed ossification of cervical rib• Delayed developmental completion• Descending shoulder girdle(esp. scalenus anticus
syndrome: middle aged female)
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Cervical Rib Syndrome
• Tx.– Conservative Tx.
• Postural correction• Physical therapy: sternoclavicular joint & acromi
oclavicular joint exercise, scalene muscle & pectoral muscle stretching
-> costoclavicular space widening• Shoulder muscle strengthening & home exercis
e program
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Cervical Rib Syndrome
• Tx.– Surgical Tx.: no improve to conservative Tx.
• Supraclavicular approach• Supraclavicular & post. parascapular approach• Transaxillary approach(Ant. Scalene muscle, middle scalene muscle, cervic
al rib, first rib & part of clavicle)
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Cervical Rib Syndrome
• Cx.– Brachial plexus injury– Subclavian vessels injury– Phrenic nerve injury– Perforation of pleura– Bleeding & hematoma– Infection
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Thank you for your attention