Q: My 54 years old mother has been suffering from severe pain in her shoulders and neck for the last year. X-rays shows that she has a cervical rib and the density of the bone has decreased (disk between the bones has been eroded). She is doing physiotherapy regularly as per the doctor’s advice. What is the permanent treatment for this problem?

A:Extra cervical rib may be an incidental finding in a small percentage of normal people. It is not necessary for this to cause any symptoms however an occasional patient may have symptoms pertaining to this. The symptomatic patients may have significant symptoms. The usual symptoms are due to a narrowing of what is called the outlet of the chest at the root of the neck. All the important vessels and nerves traverse this space between the neck and the chest through this area. The presence of an additional rib narrows this space causing pressure symptoms on the nerves and the vessels. In its simplest form it may just manifest as the pulse that disappear at your wrist when the patient takes a deep breath. The patient may have pain radiating along the nerves of the arm or pain in the neck and shoulder. At times this may be severe causing patient to have a severe burning type of pain along the arm. In very severe cases it may cause significant pressure on the blood supply to the arm. But these are very rare cases. So do not start getting worried. Majority of the patients are known to have cervical rib and seen as an incidental finding on a routine X-ray. In fact, most of these patients’ have symptoms unrelated to the cervical rib but they are attributed to the cervical rib because it has been seen on the X-ray. The differentiation is possible only by a careful physical examination and a good history.

I would recommend that not withstanding the findings of the rib on the X-ray, get her examined by a competent orthopaedic surgeon to exclude the other causes of should and arm pain. Once you have excluded of these you can then plan for the treatment of the cervical rib. For mild cases simple exercises to build up the Trapezius muscles in this the patient does shrugging exercises of the shoulder. If however, the symptoms are severe especially with physical signs referring to nerve or vessels of the arm then surgery is considered.