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Written by Administrator
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Friday, 09 October 2009 06:26 |
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Definition: Subclavian artery and the cords of brachial plexus are compressed between the scalenus ant. and the scalenus medius muscle due to:
Aetiology:
1- Presence of rib at the C7 which may be:
Complete to the manubrium.
With free end "large".
Incomplete with fibrous attachment to manubrium.
2- Narrowing with no rib due to:
Fibrous band bet C7 transverse process & manubrium.
Hyper trophy of the muscles.
Clinical Picture:
Frequently bilateral.
If unilateral common to be Lt. side.
Commoner at the age of 18 due to descent of shoulder girdle over thoracic cage.
3 Clinical types are described.
(1) Cervical rib with local symptoms.
Bony mass Pulsation poststenotic dil.
(2) Cervical rib with vascular symptoms.
Chronic ischaemia in the upper limb.
(3) Cervical rib with nerve pressure symptoms:
Numbness in the medial side of fore arm & hand.
Atrophy of the thenar then hypo thenar muscles.
Raynaud's phenomenon "vasomotor" press. on symp.
Many individuals have non symptomatizing cervical ribs seen in X-ray while others shows marked symptoms without cervical rib detected in X-ray.
Treatment:
Mild cases Muscle exercises.
Severe cases scalenotomy relieve 70% of cases.
Resistant cases Resection of the rib within its periosteum.
SOURCE: DR AYMAN SALEM'S BOOK
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Last Updated on Friday, 09 October 2009 06:37 |
