ramu's sign to clinically elicit lower cervical spinal nerve traction/compression

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Ramu’s Sign Persons with a conical neck, especially in the antero lateral area of root of neck, often feel a vague pain which aggravates by applying local pressure on the said area, rarely a radiating pain down the ipsilateral arm may also be elicited. The Brachial plexus in such situations is subjected to kink over the elevated tissue, soft and bony, caused by hypertrophic transverse processes of C7 vertebrae or cervical ribs. The kink leads to a tightness and traction on the spinal nerves, increasing with advancing age and reduced physical activity. This is demonstrable in radiographs & MRIs of root of neck. The said pain is not felt in persons with normal transverse processes of C7 vertebra or in absence of cervical rib/band. Presence of prefixed cervical spinal nerves may also give a similar sign. The point to ponder is, if hypertrophied transverse processes of C7 spine/cervical rib/cervical band happen to coexist with prefixed spinal nerves.

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A new clinical entity in evaluating cervical neural compression. Helps assess status of anatomic variation of cervical spine and cervical spinal nerves.

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Page 1: Ramu's sign to clinically elicit lower cervical spinal nerve traction/compression

Ramu’s SignPersons with a conical neck, especially in the antero lateral area of root

of neck, often feel a vague pain which aggravates by applying local

pressure on the said area, rarely a radiating pain down the ipsilateral

arm may also be elicited. The Brachial plexus in such situations is

subjected to kink over the elevated tissue, soft and bony, caused by

hypertrophic transverse processes of C7 vertebrae or cervical ribs. The

kink leads to a tightness and traction on the spinal nerves, increasing

with advancing age and reduced physical activity. This is demonstrable

in radiographs & MRIs of root of neck. The said pain is not felt in

persons with normal transverse processes of C7 vertebra or in absence of

cervical rib/band.

Presence of prefixed cervical spinal nerves may also give a similar sign.

The point to ponder is, if hypertrophied transverse processes of C7

spine/cervical rib/cervical band happen to coexist with prefixed spinalnerves.

Page 2: Ramu's sign to clinically elicit lower cervical spinal nerve traction/compression

Prominent & hypertrophied Transverse Process of C7 Vertebra

Page 3: Ramu's sign to clinically elicit lower cervical spinal nerve traction/compression

Magnified view

Prominent & hypertrophied Transverse Process of C7 Vertebra

Page 4: Ramu's sign to clinically elicit lower cervical spinal nerve traction/compression

Yet another such situation, much grosser

Note the conical form of neck & dimpled Rt. C7 transverse process

Page 5: Ramu's sign to clinically elicit lower cervical spinal nerve traction/compression

Yet another case

Bilateral Cervical Ribs

Page 6: Ramu's sign to clinically elicit lower cervical spinal nerve traction/compression

X Ray & MRI of neck of a young male with Ramu’s sign. Presented with brachialgia Right side.

Page 7: Ramu's sign to clinically elicit lower cervical spinal nerve traction/compression

EnlargedView ofthe sameMRI

Note kinkIn spinalnerves inthe firsttwo screens

Page 8: Ramu's sign to clinically elicit lower cervical spinal nerve traction/compression

X-Ray ofmy ownNeck

Page 9: Ramu's sign to clinically elicit lower cervical spinal nerve traction/compression

This feature is not a known or traceable entity in literature and I humbly dedicate this phenomenon to

my God Father Dr D Ramu garuas Ramu’s Sign

Page 10: Ramu's sign to clinically elicit lower cervical spinal nerve traction/compression

Dr V S N Rajuemail : [email protected]

WADEM 2011 BIEGING, CHINA

ARC Orthopaedic Clinic, ECIL, ARC Road, Hyderabad, INDIA