Evaluation of correlation between cervical rib and cervical plexopathy: a prospective study of clinical and radiological diagnosis, management and outcomes
Journal Title: International Journal of Orthopaedics Traumatology & Surgical Sciences - Year 2017, Vol 3, Issue 2
Abstract
Introduction: A prospective study was conducted in the department of Orthopaedics & Traumatology in D.Y Hospital, Navi Mumbai from November 2014 to October 2016 to evaluate the correlation between cervical rib and cervical plexopathy and to study clinical and radiological diagnosis, its management and outcomes. Materials & methods: Approximately 500 patients with Cervical spine pain and sign and symptoms suggesting cervical rib were screened, out of which 55 patients were evaluated during our study with long follow of 1yr. Pain in cervical region with radiculopathy bilaterally or one sided with paraesthesia, numbness, pain over upper scapular region were the symptoms which was considered before screening the patients. All the symptomatic patients were subjected to x-ray cervical spine AP and lateral with first thoracic vertebra and cervical ribs were confirmed. Treatment was both medical and physiotherapy and personal counseling. Neck instability index was used to evaluate pre treatment and post treatment scores (Minimum to maximum score 0- 50 points). Results: Out of 55 patients 4 were lost in follow and one was operated where cervical rib excision was done. Maximum patients were in age group of 35-45 years contributing to 68%. There were 31 female (62%) and 19 males (38 %). Cervical rib was right sided in 8 (16%) cases, bilateral in 38(76%) cases, left sided in 4 (8%) cases. Bilateral symptoms were seen only in 9 patients (24%), however right sided symptoms were present in 28 (62%) patients. Left sided symptoms were few in 7 cases .Maximum subjects were housewife approximating 52% followed by labourer class amounting 36 %. Cervical rib incidence was high among household, parous females and mechanical labourers and though prevalence of bilateral cervical ribs is more among general population, symptoms of plexpoathy was found more common in right side. Neck instability index pre treatment reduced drastically from 42.5 to value of 8.7 and VAS score from average 76.5mm to 8 .5mm.. Conclusion: Arriving at definitive diagnosis is more important as management for cervical spondylosis is different as compared to cervical rib or elongated transverse process. The key to management is to begin with NSAID’S and Pregabalin (as per patient tolerance) and Methylcobalamine to control radiculopathy and physiotherapy concerned with shoulder and neck muscle strengthening plus patient education pertaining to cervical rib and elongated C7 cervical process with life style modifications. All the patients responded to conservative treatment effectively once they were educated regarding their basic problem.
Authors and Affiliations
Rajendra Prasad Butala, vinit vimal karn, Dynaesh Patil, Piyush Ranjan Singh
Keywords
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