# Cervical rib - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Anatomy, Thorax, Cervical Rib - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK541001/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class LD55.00 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care - Cervical rib - disease-level clinical article (cervical-rib-clinical.txt) ## Treatment metadata - No drug therapy in primary care (Referral & Advice) ## Complete treatment card ```text CERVICAL RIB Sources: Anatomy, Thorax, Cervical Rib - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK541001/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class LD55.00 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care, Cervical rib - disease-level clinical article (cervical-rib- clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Complaints are often vague and wide-ranging, with poorly localised pain the commonest of them - Compression of the brachial plexus is the usual mechanism and produces the commonest picture - A weak hand and disturbed sensation in the limb are reported when the nerves are compressed - Because collateral vessels compensate, trouble creeps on slowly and may show only in certain arm positions - Poor posture can set the symptoms off, so look at how the patient holds themselves SIGNS - what you find (8) - Squeezing of the artery shows as a change in colour of the arm with weaker pulses - Wasting of the small muscles of the hand can be seen [muscle wasting] - Loss of bulk in abductor pollicis brevis together with the hypothenar muscles is the Gilliatt- Sumner hand - With the head extended, bent to one side and pressed down from above, radicular pain should be reproduced - For suspected arterial compression, use the Adson manoeuvre with the shoulder extended and a little abducted - The patient extends the neck and turns towards the examiner while the radial pulse is felt; a fading pulse means the artery is being compromised - In the Roos test both shoulders are abducted and turned out with elbows bent to 90 degrees while the hands open and close; tiring or return of symptoms is positive - Compare the two arms for symmetry and range of movement at the start of the examination [reduced range of movement] TESTS (6) - Begin with a plain chest or cervical spine radiograph - That simple film shows the anatomy that is usually to blame - Ultrasound is of limited use here, because the whole region of interest cannot be seen - Angiography is hampered because the arterial form depends on posture and will not appear to order - Electrodiagnostic work is the traditional route for the nerve form, and confirms the diagnosis when positive, though the compression is often intermittent - A drop below 85 m/s counts as positive, and an overall speed under 60 m/s is taken to indicate surgery IF NOT THIS - what else fits (8) - Pectoralis minor syndrome, with pain at the front of the chest, over trapezius and over the scapula, sometimes with arm or hand paraesthesiae - In that syndrome it is the pectoralis minor muscle that traps the nerves, not the outlet itself - Injury to the brachial plexus - Injury of the cervical spine - Radiculopathy arising in the neck - Impingement at the shoulder - Overuse injury of the elbow or forearm - Injury of the acromioclavicular joint Source StatPearls "Thoracic Outlet Syndrome" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult An extra rib arising from the lowest neck vertebra; usually an incidental finding, but can compress adjacent nerves or vessels causing thoracic outlet syndrome, which needs vascular or thoracic surgical referral. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why An extra rib arising from the lowest neck vertebra; usually an incidental finding, but can compress adjacent nerves or vessels causing thoracic outlet syndrome, which needs vascular or thoracic surgical referral. Caution RED FLAG - Subclavian artery aneurysm or thrombosis: assess urgently and refer. Arm ischemia or diminished pulses, progressive weakness or paraesthesia in the arm suggesting vascular or neurologic thoracic outlet compression. No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to. RED FLAG - Severe vascular compromise or atrophy of intrinsic hand muscles requires surgical intervention. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)