The syndrome involves irritation or compression of the neurovascular bundles normally associated with the 1st rib (most commonly affects the subclavian artery and/or the lower trunk of the trunk of the brachial plexus)

cervical rib can go on to cause a clinically known condition known as thoracic outlet syndrome (TOS) only 10% of cervical rib cases go on to cause this. (TOS can also occur without the prescence of cervical rib)

symptoms of thoracic outlet syndrome include the following

There may be pain, numbness or tingling of the upper limb. Symptoms are often vague and general and may affect the whole arm. There may be a painful neck and headache too • Autonomic features, such as cold hands, swelling or blanching, can occur. Stellate ganglion involvement may also occur (a collection of sympathetic nerves found anterior to the neck of the first rib, provides most of the sympathetic innervation to the head, neck, upper extremity, and a portion of the upper thorax)

questions

• From anterior to posterior name the neurovascular structures that lie on the first rib

(the subclavian artery and/or the lower trunk of the trunk of the brachial plexus)

• Which part of the brachial plexus lies on the first rib?

the medial branch inc C8 & T1

• What is the root value of this structure?

it provides the ulnar and median nerve function

• Which muscles are most likely to be affected by this structure being stretched over a cervical rib?

the muscles present in the anterior 3 layers of the forearm and the hypothenar hyperthenar and interosseous muscles in the hand

• what test would you use to asses these muscles?