Images in Neurosurgery

Cervical rib presenting with neurogenic thoracic outlet syndrome

A 16-year-old girl presented to our neurosurgery clinic with a 6-month history of paresthesias along the medial aspect of the right forearm and hand. On physical examination, she had right grip weakness and mild atrophy of the right hypothenar and interosseous muscles. A bony mass was palpated just above the right clavicle. Computed tomography of the chest showed a complete right cervical rib (Figures 1 and 2, black arrow), arising from the C7 vertebral body and attaching to the first thoracic rib, and an incomplete left cervical rib (Figures 1 and 3, white arrow). A cervical rib is the most common cause of neurogenic thoracic outlet syndrome from compression of the medial cord or inferior trunk of the brachial plexus. We collaborated with a cardiothoracic surgeon to resect the right cervical rib. At 6-month follow-up, the patient reported complete resolution of right arm paresthesias and significant improvement in right grip strength.

Xray of cervical ribFigure 1.

Xray of cervical ribFigure 2.

Xray of cervical ribFigure 3.

Submitted by:

Rimal H. Dossani, MD, and Anthony Sin, MD
Affiliations: Louisiana State University Health Sciences Center-Shreveport Department of Neurosurgery