Vague pain with a sensation of pins and needles along the left arm.
The patient presented with vague pain and a sensation of pins and needles along the left hand. Chest radiographs and a cervical spine series were performed. On the chest and cervical radiographs, an osseous structure was seen arising from the transverse process of the seventh cervical vertebra. The transvese process of the same vertebra on the right side was elongated. The diagnosis was of a cervical rib on the left side.
A cervical rib is a common anomaly and arises from the transverse process of the seventh cervical vertebra (or rarely the sixth and very rarely the fifth). The rib reflects hyperplasia of the transverse process secondary centre of ossification. It is more common in females, occurring in 11% of the general population, and is slightly more common on the right side. It may be associated with spinal anomalies. Occasionally it is just a fibrous band or a complete rib with articulation with the manubrium or the first rib. The transverse processes of the cervical vertebrae slope downward from the neural arch, whereas they slope upwards in the thoracic region. This anatomical difference helps to differentiate between a cervical rib and a rudimentary first rib.
Cervical ribs occur either unilaterally or bilaterally. They vary greatly in size and shape, and the clinical symptoms have very little relationship to the size and shape. Very small cervical ribs with a fibrous attachment to the first rib can cause more symptoms than large ones. A fibrous band of varying thickness and width is anatomically bound to the cervical rib in a plane parallel to the scalenus muscles. Compression of the adjacent neurovascular bundle can cause symptoms. Occasionally, a large transverse process can mimic a rib and the associated symptoms.
Plain films are usually diagnostic, however MRI can demonstrate the fibrous attachment better.
Various surgical methods have been described to alleviate the symptoms.
Cervical rib
From the anterior-posterior X-ray of the cervical spine and chest, a rib-like bony structure can be observed at the transverse process of the seventh cervical vertebra, more apparent on the left side. It projects laterally and is partially continuous or separate from adjacent structures. This structure is located higher than the normal first rib, and its morphology suggests a significantly elongated transverse process or an independent ossification center forming a rib-like structure. Given that the patient is female and reports tingling and dull aching in the left upper limb, these findings indicate a likely cervical rib on the left side.
Considering the patient’s age (25-year-old female), symptoms (tingling and slight pain in the left upper limb), and X-ray findings of a rib-like structure arising from the transverse process of the seventh cervical vertebra, the most likely diagnosis is:
Left Cervical Rib.
If symptoms worsen or if vascular and nerve compression appear to increase, additional investigations such as MRI, vascular ultrasound, or nerve conduction studies are recommended to assess the degree of compression.
For cervical rib-induced numbness or discomfort in the upper limb, treatment strategies primarily include:
Recommended Rehabilitation Exercise Prescription (Based on FITT-VP Principle):
Special Notes:
Disclaimer: This report is based solely on the provided imaging and brief medical history for reference and does not substitute for an in-person consultation or a professional medical diagnosis and treatment. If you have any questions or your symptoms worsen, please consult a medical professional for a personalized evaluation and treatment plan.
Cervical rib
