Cervical Rib

Hi Physios,
Please can u suggest the conservative management for Cervical rib.I would like to know if traction and stretching will be beneficial to the patient?if so ,can u advise about the type of traction to be used.
regards
angel

Hi,

I would suggest Intermittent Cervical Traction for 10-12mints in this case.Hot packs and Self Shoulder Mobilization Exercises also would be beneficial

Dear Colleague,

I have got some patients having same conditions, and for them i have used Continuous traction for 15 minutes in alternative days. and the position of the patient is sitting and the head was protracted and forward flexed. i have got very good result after 10 sessions of traction.

Lets try that.

Sazal,Bangladesh

"cervical rib" is not a diagnosis, this is an anatomical feature which may or may not be implicated in the aetiology of cervicothoracic protective responses leading to pain or dysfunction. The important thing to remember is that wether these protoribs are implicated or not , the approach that has the best chance of achieving good results is the same as if the same features were not present. This being , to restore normal movement dynamics to the spine.

It will be good to start a programme of cervicothoracic Stabilization exercises ( Flexibility, postural training and strengthening) as that will be a good way to manage a cervical rib.

hi friends
cervical rib as such may not cause any symptoms.mostly it is diagnosed while doing some routine check up.symtoms arises when the cervical rib or associated anomalous bands cause compression of lower cervical nerve roots.if its causes irritation of the nerve roots and lower its threshold to mechanical stimulation,it results in cervicobrachial pain syndrome.then the treatment programme should should be the one for mechanosensitivity described by elvey and hall.later our treatment programme should include shoulder girdle elevation exercise,scapular muscle stabilization exercise

Ideally cervical traction is contraindicated in cervical rib.However, manual stretching of scaleni, trapezius, levator scapulae and other neck muscles along with classical treatment for upper crossed syndrome such as suboccipital release, pectorals stretching, retractor strengthening,depp neck flexors stretching, shoulder elevator strengthening and Jacobson’s relaxation technique or deep breathing techniques will help to minimizes muscle tension as well as psychological changes that accompany this condition.Appliances such as therpeutic pillow, cervical brace, breast support, heat in form of diathermy or infra red rays , ultrasound, TENS for minimising pain and inflammation at cervicobrachial region are considered as a good options including slef mobilisation of first rib. However, remember that once the stretching is started there is a chance of aggravation in initial few days and later it strats settling but ideally the prognosis depends on wheather it is neural, arterial, venous or combined type of TOS lesion and its been noted that Neurogenic thoracic outlet syndrome usually requires chronic pain management, vascular thoracic outlet may have better outcome with appropriate management and patients with profound intrinsic muscle atrophy do not regain their function. Appropriate surgery may arrest the progressive deterioration.Kindly refer Welcome to Thoracic Outlet Syndrome for further details or contact me personally Subhash khatri 09845857601 for further details [email protected]

hi,
i really want too know how can we treat the patient with cervical rib i see a patient having cervical rib she is having severe pain in neck,shoulder,and back she is using colllar now what stratgies should i doo too relieve her in acute stage she is also complaining of headache and vertigo plz reply me as soon as

Hi!
At present you can treat your patient with HF TENS for 20 min,and treatment for upper crossed syndrome that is suboccipital release,pectoral stretching,deep neck flexors strengthening and retractors of scapule strengthening for at least 6weeks. if you think that vetigo is due to VBI then avoid rotational exs or manual therapy.
regards
subhash khatri

Why head protraction and forward flexion? This question for some PT who suggest neck tration for cervical rib?

Hi zisuer

Have you read this study regarding cervical traction:

PEDro - Detailed Search Results

I think this may be the only solid evidence for a treatment for Thoracic Outlet Syndrome and I don't think there are any specifically for the diagnosis of cervical rib - so it depends how your patient presents.

The only think I would add is that the authors conclude that hot pack and exercise was beneficial - because the control group got this and they got somewhat better whereas the experimental group got this + cervical traction and got a whole lot better. So if one goes of the between groups comparison which is the important part: it is the cervical traction that really improved matters where as the heat and exercise may or may not have a placebo or were going to get somewhat better anyway- we don't know