Cervical Rib

What is a cervical rib?

A cervical rib is an extra bone you may have in your neck at birth. This rare bone doesn’t look like a typical rib in your chest. It can be more vertical or diagonal instead of horizontal like the ribs in your chest. It starts from the lowest bone in your neck and can extend to the first (top) rib in your chest. A cervical rib doesn’t do anything — it doesn’t have a function.

In most people, a cervical rib doesn’t cause issues. In others, it causes pain in their arm or difficulty using their hand to grip a pen, for example.

Types of cervical ribs

There are four cervical rib types:

• Type 1 is a complete rib that reaches your first rib.
• Type 2 is an incomplete rib with one end that doesn’t attach to anything.
• Type 3 is an incomplete rib that attaches to a fibrous band.
• Type 4 is a short bone that sticks out from the lowest vertebra in your cervical spine (in your neck).

How common is a cervical rib?

A cervical rib (cervical rib syndrome) is rare. Up to 1% of people have one (and sometimes two) cervical ribs at birth. Cervical ribs happen more in people assigned female at birth (AFAB). For every person assigned male at birth (AMAB) with a cervical rib, there are two AFAB people with the condition.

Nearly 30% of people who have thoracic outlet syndrome have cervical ribs.

What are the symptoms?

Cervical rib symptoms include:

• Neck or arm pain.
• A lump in your neck.
• Tingling or numbness in your hand or arm.
• Weakness in your hand and forearm muscles.
• Clawing (bending) of your fingers except your thumb and index finger.

Most people don’t have symptoms of cervical rib. You’re more likely to have symptoms if you have bad posture or have experienced trauma to your upper body.

What causes a cervical rib?

Researchers think a mutation (change) in HOX genes involved in skeletal development may cause cervical ribs. Cells in a developing fetus may form a bone in the wrong place and it becomes a cervical rib.

What are the complications of a cervical rib?

Cervical ribs can compress a nerve or your subclavian artery. A cervical rib can cause thoracic outlet syndrome, which can be dangerous without treatment.

How is a cervical rib diagnosed?

A healthcare provider can do a physical exam that includes an Adson test. If your cervical rib is compressing your subclavian artery, a provider can feel your extended arm’s pulse get weaker when you turn your head.

Most of the time, providers find cervical ribs when they’re looking for something else. Cervical ribs can show up on a chest X-ray or cervical (neck) X-ray.

Providers may use other tests to make a diagnosis, like:

• MRI (magnetic resonance imaging).
• CT (computed tomography) scan.
• Nerve conduction studies to see how well your nerves are working.
• Electromyography (EMG) to see how well your skeletal muscles and nerves are working.
• Evoked potential tests to see how well nerve signals are getting to your brain.

How is a cervical rib treated?

If you don’t have symptoms, you won’t need treatment.

If you have symptoms, treatments may include:

• Physical therapy. This can treat a cervical rib’s compression of a nerve.
• Medicines. Muscle relaxers or pain relievers can help with discomfort.
• Cervical rib removal. A provider can perform surgery if the rib is causing thoracic outlet syndrome. For better symptom prevention, a surgeon may also remove your first rib along with the cervical rib. Any surgery carries a risk of bleeding or infection. The average recovery time after surgery is about nine weeks.

Can a cervical rib be prevented?

No, you can’t prevent cervical ribs because they develop before birth.

What can I expect if I have a cervical rib?

If you have symptoms, they can get worse without treatment. You can also get blood clots in your subclavian artery or brain.

The outlook is good for people who have surgery to remove a cervical rib. Their affected arm works normally again and symptoms rarely return after surgery.

How do I take care of myself?

Follow your provider’s instructions for getting medical treatment. If nonsurgical treatments don’t help you, ask your provider if surgery would be right for you.

When should I see my healthcare provider?

If your cervical rib starts causing symptoms, contact your provider.

If you have surgery to treat a cervical rib, you’ll need follow-up appointments with your provider. They’ll want to see how well your body is healing and make sure you’re not having any issues. You may also need to do physical therapy for a number of weeks after your operation.

What questions should I ask my doctor?

Questions to consider asking your healthcare provider include:

• What type of cervical rib do I have?
• Do I need treatment?
• What’s the best treatment for me?
• Are my future children at risk of inheriting a cervical rib?