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Leckenby J, Smith H, Catanzaro M, Reavey P. Compressive Neuropathies of the Upper Extremity: Anatomy for the Peripheral Nerve Surgeon. Hand Clin 2024; 40:315-324. [PMID: 38972676 DOI: 10.1016/j.hcl.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
Advance knowledge of anatomy is a prerequisite for the peripheral nerve surgeon. This article serves to provide an outline of anatomic regions where nerve entrapment or compression can occur. Each section is subdivided into anatomic regions where the etiology, indications, and relevant and aberrant anatomy are discussed, as well as common surgical approaches to the problematic anatomic site. The purpose is to provide an overview for the peripheral nerve surgeon and offer a valuable resource to provide a better understanding and optimal care for this patient population.
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Affiliation(s)
- Jonathan Leckenby
- Division of Plastic Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA; Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, USA.
| | - Hannah Smith
- Division of Plastic Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Michael Catanzaro
- Division of Plastic Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Patrick Reavey
- Division of Plastic Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA; Division of Hand Surgery, Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA
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2
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Vilanilam GK, Gopal N, Middlebrooks EH, Huang JF, Bhatt AA. Compressive lesions of the head and neck: Common and uncommon must-know entities. Neuroradiol J 2024; 37:164-177. [PMID: 37026517 PMCID: PMC10973822 DOI: 10.1177/19714009231166083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
There are many lesions that cause compression of nerves and vessels in the head and neck, and they can often be overlooked in the absence of adequate history or if not suspected by the radiologist. Many of these lesions require a high index of suspicion and optimal positioning for imaging. While a multimodality approach is critical in the evaluation of compressive lesions, an MRI utilizing high-resolution (heavily weighted) T2-weighted sequence is extremely useful as a starting point. In this review, we aim to discuss the radiological features of the common and uncommon compressive lesions of the head and neck which are broadly categorized into vascular, osseous, and miscellaneous etiologies.
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Affiliation(s)
- George K Vilanilam
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Neethu Gopal
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Erik H Middlebrooks
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Alok A Bhatt
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
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3
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Hults CM, Ding Y, Xie GG, Raja R, Johnson W, Lee A, Simons DJ. Inattentional blindness in medicine. Cogn Res Princ Implic 2024; 9:18. [PMID: 38536589 PMCID: PMC10973299 DOI: 10.1186/s41235-024-00537-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/09/2024] [Indexed: 05/15/2024] Open
Abstract
People often fail to notice unexpected stimuli when their attention is directed elsewhere. Most studies of this "inattentional blindness" have been conducted using laboratory tasks with little connection to real-world performance. Medical case reports document examples of missed findings in radiographs and CT images, unintentionally retained guidewires following surgery, and additional conditions being overlooked after making initial diagnoses. These cases suggest that inattentional blindness might contribute to medical errors, but relatively few studies have directly examined inattentional blindness in realistic medical contexts. We review the existing literature, much of which focuses on the use of augmented reality aids or inspection of medical images. Although these studies suggest a role for inattentional blindness in errors, most of the studies do not provide clear evidence that these errors result from inattentional blindness as opposed to other mechanisms. We discuss the design, analysis, and reporting practices that can make the contributions of inattentional blindness unclear, and we describe guidelines for future research in medicine and similar contexts that could provide clearer evidence for the role of inattentional blindness.
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Affiliation(s)
- Connor M Hults
- University of Illinois at Champaign-Urbana, Champaign, USA
| | - Yifan Ding
- University of Illinois at Champaign-Urbana, Champaign, USA
| | - Geneva G Xie
- University of Illinois at Champaign-Urbana, Champaign, USA
| | - Rishi Raja
- University of Illinois at Champaign-Urbana, Champaign, USA
| | | | - Alexis Lee
- University of Illinois at Champaign-Urbana, Champaign, USA
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Abraham P, Lecoq S, Mechenin M, Deveze E, Hersant J, Henni S. Role of Lifestyle in Thoracic Outlet Syndrome: A Narrative Review. J Clin Med 2024; 13:417. [PMID: 38256551 PMCID: PMC10816325 DOI: 10.3390/jcm13020417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/20/2023] [Accepted: 01/07/2024] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION The presence of a positional compression of the neurovascular bundle in the outlet between the thorax and the upper limb during arm movements (mainly abduction) is common but remains asymptomatic in most adults. Nevertheless, a certain number of subjects with thoracic outlet positional compression will develop incapacitating symptoms or clinical complications as a result of this condition. Symptomatic forms of positional neurovascular bundle compression are referred to as "thoracic outlet syndrome" (TOS). MATERIALS AND METHODS This paper aims to review the literature and discuss the interactions between aspects of patients' lifestyles in TOS. The manuscript will be organized to report (1) the historical importance of lifestyle evolution on TOS; (2) the evaluation of lifestyle in the clinical routine of TOS-suspected patients, with a description of both the methods for lifestyle evaluation in the clinical routine and the role of lifestyle in the occurrence and characteristics of TOS; and (3) the influence of lifestyle on the treatment options of TOS, with a description of both the treatment of TOS through lifestyle changes and the influence of lifestyle on the invasive treatment options of TOS. RESULTS We report that in patients with TOS, lifestyle (1) is closely related to anatomical changes with human evolution; (2) is poorly evaluated by questionnaires and is one of the factors that may induce symptoms; (3) influences the sex ratio in symptomatic athletes and likely explains why so many people with positional compression remain asymptomatic; and (4) can sometimes be modified to improve symptoms and potentially alter the range of interventional treatment options available. CONCLUSIONS Detailed descriptions of the lifestyles of patients with suspected TOS should be carefully analysed and reported.
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Affiliation(s)
- Pierre Abraham
- Service of Sports Medicine, University Hospital, 49100 Angers, France;
- Service of Vascular Medicine, University Hospital, 49100 Angers, France (J.H.)
- INSERM, CNRS, MITOVASC, Equipe CarMe, SFR ICAT, University Angers, 49100 Angers, France
| | - Simon Lecoq
- Service of Sports Medicine, University Hospital, 49100 Angers, France;
- Service of Vascular Medicine, University Hospital, 49100 Angers, France (J.H.)
| | - Muriel Mechenin
- Service of Vascular Medicine, University Hospital, 49100 Angers, France (J.H.)
| | - Eva Deveze
- Service of Thoracic and Vascular Surgery, University Hospital, 49100 Angers, France
| | - Jeanne Hersant
- Service of Vascular Medicine, University Hospital, 49100 Angers, France (J.H.)
| | - Samir Henni
- Service of Vascular Medicine, University Hospital, 49100 Angers, France (J.H.)
- INSERM, CNRS, MITOVASC, Equipe CarMe, SFR ICAT, University Angers, 49100 Angers, France
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5
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Prevalence of cervical ribs and elongated transverse processes in Omani population: a computed tomography-based study. SURGICAL AND RADIOLOGIC ANATOMY : SRA 2022; 44:1361-1366. [PMID: 36190533 DOI: 10.1007/s00276-022-03028-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 09/26/2022] [Indexed: 10/10/2022]
Abstract
INTRODUCTION Cervical ribs are the supernumerary ribs that usually arise from the seventh cervical vertebra. Ethnic and geographical variations in cervical ribs and elongated transverse processes have been reported. Therefore, we aimed to study the prevalence of cervical ribs and elongated transverse processes and morphometry of cervical ribs in Omani subjects using computed tomography (CT). METHODS A total of 1165 consecutive patients' CT scans of the cervical spine who had visited the tertiary care hospital from January 2016 to December 2020 were included in the study. The CT scans were screened for cervical ribs and elongated C7 transverse processes. Fisher's exact test was used to determine the gender influence. RESULTS Cervical ribs were identified in 0.94% of patients with a male-to-female ratio of 0.37:1. Most cervical ribs were unilateral (54%). The elongated C7 transverse process was identified in 18.45% of patients, with a male-to-female ratio of 1.36:1. Female patients are more likely to have cervical ribs (effect size = 5.98, 95% CI = 1.58-22.6, p = 0.005) than male patients. In contrast, the elongated C7 transverse process is more frequent in males (effect size = 1.82, 95% CI = 1.34-2.47, p < 0.001). The length and width of the cervical ribs are presented. CONCLUSION The prevalence of cervical ribs in Omani subjects is close to that of accepted prevalence worldwide. However, the elongated C7 transverse process prevalence is comparatively high and close to the Saudi population.
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Dengler NF, Ferraresi S, Rochkind S, Denisova N, Garozzo D, Heinen C, Alimehmeti R, Capone C, Barone DG, Zdunczyk A, Pedro MT, Antoniadis G, Kaiser R, Dubuisson A, Kretschmer T, Rasulic L. Thoracic Outlet Syndrome Part I: Systematic Review of the Literature and Consensus on Anatomy, Diagnosis, and Classification of Thoracic Outlet Syndrome by the European Association of Neurosurgical Societies' Section of Peripheral Nerve Surgery. Neurosurgery 2022; 90:653-667. [PMID: 35319532 PMCID: PMC9514726 DOI: 10.1227/neu.0000000000001908] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/05/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although numerous articles have been published not only on the classification of thoracic outlet syndrome (TOS) but also on diagnostic standards, timing, and type of surgical intervention, there still remains some controversy because of the lack of level 1 evidence. So far, attempts to generate uniform reporting standards have not yielded conclusive results. OBJECTIVE To systematically review the body of evidence and reach a consensus among neurosurgeons experienced in TOS regarding anatomy, diagnosis, and classification. METHODS A systematic literature search on PubMed/MEDLINE was performed on February 13, 2021, yielding 2853 results. Abstracts were screened and classified. Recommendations were developed in a meeting held online on February 10, 2021, and refined according to the Delphi consensus method. RESULTS Six randomized controlled trials (on surgical, conservative, and injection therapies), 4 "guideline" articles (on imaging and reporting standards), 5 observational studies (on diagnostics, hierarchic designs of physiotherapy vs surgery, and quality of life outcomes), and 6 meta-analyses were identified. The European Association of Neurosurgical Societies' section of peripheral nerve surgery established 18 statements regarding anatomy, diagnosis, and classification of TOS with agreement levels of 98.4 % (±3.0). CONCLUSION Because of the lack of level 1 evidence, consensus statements on anatomy, diagnosis, and classification of TOS from experts of the section of peripheral nerve surgery of the European Association of Neurosurgical Societies were developed with the Delphi method. Further work on reporting standards, prospective data collections, therapy, and long-term outcome is necessary.
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Affiliation(s)
- Nora Franziska Dengler
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany;
| | - Stefano Ferraresi
- Department of Neurosurgery, Ospedale Santa Maria della Misericordia, Rovigo, Italy;
| | - Shimon Rochkind
- Division of Peripheral Nerve Reconstruction, Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv-Yafo, Israel;
| | - Natalia Denisova
- Department of Functional Neurosurgery, Federal Neurosurgical Center, Novosibirsk, Russia
| | - Debora Garozzo
- Department of Neurosurgery, Mediclinic Parkview Hospital, Dubai, United Arab Emirates
| | - Christian Heinen
- Peripheral Nerve Unit Nord, Christliches Krankenhaus Quakenbrück GmbH, Quakenbrück, Germany;
| | - Ridvan Alimehmeti
- Department of Neurosurgery at University Hospital Center “Mother Theresa”, Tirana, Albania;
| | - Crescenzo Capone
- Department of Peripheral Nerve Surgery, Ospedale Civile di Faenza, Local Health Authority of Romagna, Faenza, Italy;
| | | | - Anna Zdunczyk
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany;
| | - Maria Teresa Pedro
- Peripheral Nerve Unit, Department of Neurosurgery, BKH Günzburg at Ulm University, Günzburg, Germany
| | - Gregor Antoniadis
- Peripheral Nerve Unit, Department of Neurosurgery, BKH Günzburg at Ulm University, Günzburg, Germany
| | - Radek Kaiser
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, Praha, Czech Republic;
| | - Annie Dubuisson
- Department of Neurosurgery, CHU Liège, Avenue de L’Hôpital 1, Liège, Belgium;
| | - Thomas Kretschmer
- Department of Neurosurgery & Neurorestoration, Klinikum Klagenfurt, Klagenfurt am Wörthersee, Austria;
| | - Lukas Rasulic
- Faculty of Medicine, University of Belgrade, Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
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7
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Bint I Bilal A, Gul MI, Ata F, Ibrahem RE, Danjuma MI. Exercise‐induced thoracic outlet syndrome and concomitant osteomyelitis in cervical rib with a possible familial origin: A case report. Clin Case Rep 2022; 10:e05514. [PMID: 35474983 PMCID: PMC9033646 DOI: 10.1002/ccr3.5514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/13/2022] [Accepted: 02/16/2022] [Indexed: 11/18/2022] Open
Abstract
Cervical ribs are rare and usually asymptomatic. Occasionally, they can cause nerve impingements and compressive symptoms. In cervical ribs, osteomyelitis secondary to trauma is unheard of. We report such a case made more interesting by the familial presence of bilateral cervical ribs in two generations, indicating a familial origin.
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Affiliation(s)
| | | | - Fateen Ata
- Department of Internal Medicine Hamad Medical Corporation Doha Qatar
| | | | - Muhammad I. Danjuma
- Department of Internal Medicine Hamad Medical Corporation Doha Qatar
- College of Medicine Qatar University Doha Qatar
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8
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Abstract
Arterial thoracic outlet syndrome is rare and may be associated with a bony anomaly. Patient presentation can range from mild arm discoloration and claudication to severe limb-threatening ischemia. For patients with subclavian artery dilation without secondary complications, thoracic outlet decompression and arterial surveillance is sufficient. Patients with subclavian artery aneurysms or distal embolization require decompression with reconstruction or thromboembolectomy and distal bypass respectively.
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Affiliation(s)
- Louis L Nguyen
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | - Andrew J Soo Hoo
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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9
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Hurdle MFB, Ferreira-Dos-Santos G, Rosario-Concepcion R, Gil LV, Eldrige JS, Clendenen SR. Counting ribs and thoracic levels under ultrasound: a systematized technical protocol for both posterior and anterior approaches. Reg Anesth Pain Med 2021; 46:452-454. [PMID: 33402417 DOI: 10.1136/rapm-2020-102050] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 11/03/2022]
Abstract
Over the last two decades, the clinical applications of diagnostic and interventional ultrasound have expanded rapidly. When analyzing the chest wall and thoracic region, ultrasound has previously been shown to reliably identify chest wall pathologies like rib fracture and slipping rib syndrome, as well as having fundamentally changed perioperative management and patient outcomes after the emergence of point-of-care ultrasound. In addition, ultrasound guidance has recently become more popular for multiple blocks in the field of regional anesthesia and pain medicine. In this technical report, we systematize an ultrasound-guided protocol for counting ribs and thoracic levels for both posterior and anterior approaches, which does not require level confirmation by fluoroscopy. With this protocol, we hope to create an effective educational resource to support physicians from any specialty background as they engage in point-of-care ultrasound applications in the thoracic region.
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Affiliation(s)
- Mark Friedrich B Hurdle
- Department of Pain Medicine, Mayo Clinic College of Medicine and Science, Jacksonville, Florida, USA
| | | | - Raul Rosario-Concepcion
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Jacksonville, Florida, USA
| | - Laura V Gil
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Jacksonville, Florida, USA
| | - Jason S Eldrige
- Department of Pain Medicine, Mayo Clinic College of Medicine and Science, Jacksonville, Florida, USA
| | - Steven R Clendenen
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Jacksonville, Florida, USA
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10
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Neural entrapments associated with musculoskeletal anatomical variations of the upper limb: Literature review. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2020.100094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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11
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de Farias LDPG, Menezes DC, Faé IS, de Arruda PHC, Santos JMMM, Teles GBDS. Anatomical variations and congenital anomalies of the ribs revisited by multidetector computed tomography. Radiol Bras 2020; 53:413-418. [PMID: 33304010 PMCID: PMC7720665 DOI: 10.1590/0100-3984.2019.0131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
As they are asymptomatic or have a nonspecific, anatomical variations of the ribs are usually detected as incidental findings on imaging studies. They may be isolated changes or can be related to anomalies or clinical syndromes. Such variations are easily overlooked on conventional radiography and computed tomography if they are not actively investigated, mainly because most indications for a chest X-ray studies aim to evaluate the lung parenchyma and mediastinal structures. The objective of this pictorial essay was to use multislice computed tomography images to illustrate the imaging aspects of the main anatomical variations and congenital anomalies of the ribs.
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12
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Zurkiya O, Ganguli S, Kalva SP, Chung JH, Shah LM, Majdalany BS, Bykowski J, Carter BW, Chandra A, Collins JD, Gunn AJ, Kendi AT, Khaja MS, Liebeskind DS, Maldonado F, Obara P, Sutphin PD, Tong BC, Vijay K, Corey AS, Kanne JP, Dill KE. ACR Appropriateness Criteria® Thoracic Outlet Syndrome. J Am Coll Radiol 2020; 17:S323-S334. [PMID: 32370976 DOI: 10.1016/j.jacr.2020.01.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/22/2020] [Indexed: 10/24/2022]
Abstract
Thoracic outlet syndrome (TOS) is the clinical entity that occurs with compression of the brachial plexus, subclavian artery, and/or subclavian vein at the superior thoracic outlet. Compression of each of these structures results in characteristic symptoms divided into three variants: neurogenic TOS, venous TOS, and arterial TOS, each arising from the specific structure that is compressed. The constellation of symptoms in each patient may vary, and patients may have more than one symptom simultaneously. Understanding the various anatomic spaces, causes of narrowing, and resulting neurovascular changes is important in choosing and interpreting radiological imaging performed to help diagnose TOS and plan for intervention. This publication has separated imaging appropriateness based on neurogenic, venous, or arterial symptoms, acknowledging that some patients may present with combined symptoms that may require more than one study to fully resolve. Additionally, in the postoperative setting, new symptoms may arise altering the need for specific imaging as compared to preoperative evaluation. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Omar Zurkiya
- Research Author, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | | | - Sanjeeva P Kalva
- Panel Chair, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Lubdha M Shah
- Panel Chair, University of Utah, Salt Lake City, Utah
| | | | | | - Brett W Carter
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ankur Chandra
- Scripps Green Hospital, La Jolla, California; Society for Vascular Surgery
| | | | - Andrew J Gunn
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - David S Liebeskind
- University of California Los Angeles, Los Angeles, California; American Academy of Neurology
| | - Fabien Maldonado
- Vanderbilt University Medical Center, Nashville, Tennessee; American College of Chest Physicians
| | - Piotr Obara
- Loyola University Medical Center, Maywood, Illinois
| | | | - Betty C Tong
- Duke University School of Medicine, Durham, North Carolina; The Society of Thoracic Surgeons
| | | | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Karin E Dill
- Specialty Chair, UMass Memorial Medical Center, Worcester, Massachusetts
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13
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Partiot C, Guillon M, Peressinotto D, Castex D, Maureille B. Cervical ribs in human early life: morphological variability and first identification as a morbidity criterion in a past population. J Anat 2020; 237:119-132. [PMID: 32187701 DOI: 10.1111/joa.13178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/16/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022] Open
Abstract
Despite the medical literature on supernumerary cervical ribs in extant adult samples, little is known about their development and occurrence in early infancy. The documentation of cervical ribs in modern samples of fetuses and neonates is indeed affected by ethical as well as technical limitations. The aim of the present study was to investigate their frequencies and morphological variability in the first known archaeological collection of very young children with this anatomical variant. The study sample comes from the 8B-51 necropolis on the Saï island (Sudan) and dates to the Classic Kerma Period (XVIIIe-XVIe centuries BC). It consists of 64 individuals deceased between 24 weeks of amenorrhoea and 2 years of age. Bilateral or unilateral cervical ribs were found in 27 individuals. A total of 43 cervical ribs were identified, 38 of which are fully preserved. According to these observations, at least 42% of the individuals have unilateral or bilateral cervical ribs, with an average maximum length of < 1 cm. This frequency is very high compared to those observed in contemporary adult samples (up to 3%). First, the comparison of our results with biological and genetic research demonstrating the link between the occurrence of cervical ribs and a reduced chance of survival during infancy allows the first identification of this trait as an indicator of morbidity in an archaeological collection, a morbidity to which a genetic homogeneity or even endogamy could contribute. Second, the number of ribs studied makes it possible to propose a morphological classification based on the general shape and the shape of the articular facets, classification that can be used tos refine the analyses of the trait in future samples.
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Affiliation(s)
- Caroline Partiot
- UMR 5199 PACEA, CNRS, Université de Bordeaux, Pessac Cedex, France
| | - Mark Guillon
- UMR 5199 PACEA, CNRS, Université de Bordeaux, Pessac Cedex, France.,Inrap, Boulevard de Verdun, Le Grand Quevilly, France
| | - David Peressinotto
- UMR 5199 PACEA, CNRS, Université de Bordeaux, Pessac Cedex, France.,Hades Archéologie, Balma, France
| | - Dominique Castex
- UMR 5199 PACEA, CNRS, Université de Bordeaux, Pessac Cedex, France
| | - Bruno Maureille
- UMR 5199 PACEA, CNRS, Université de Bordeaux, Pessac Cedex, France
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14
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Cervical ribs and other abnormalities of the vertebral pattern in children with esophageal atresia and anorectal malformations. Pediatr Res 2020; 87:773-778. [PMID: 31645054 DOI: 10.1038/s41390-019-0631-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/26/2019] [Accepted: 09/29/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND In mammals the vertebral column has a constant pattern, particularly in the cervical region, which is likely the result of stabilizing selection. The prevalence of cervical ribs and extended vertebral pattern abnormalities is increased in deceased fetuses and neonates and associated with structural and chromosomal anomalies. The hypothesized close interaction between vertebral patterning and organogenesis in early embryogenesis could be studied in children with esophageal atresia and anorectal malformations by evaluating the radiographs of the vertebral column and the type and number of associated anomalies METHODS: The vertebral pattern of 367 children diagnosed with an esophageal atresia (n = 135), anorectal malformation (n = 215), or both (n = 17) was assessed on radiographs. RESULTS The vertebral pattern was abnormal in 170/202 (84.2%) children in whom this could be assessed, and cervical ribs were present in 147/335 (43.9%). Extended vertebral pattern abnormalities became more frequent with an increasing number of associated structural abnormalities. Cervical ribs were particularly common in children with chromosomal and genetic abnormalities (18/20, 90.0%). CONCLUSIONS Cervical ribs are frequent and abnormal vertebral patterns are more extended in the presence of associated anomalies. These findings support the hypothesized selection against vertebral patterning variations and emphasize the relevance of assessment of the vertebral pattern.
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15
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Plaza Aulestia N, Rodríguez Montero S, Velloso Feijoo ML. Double cervical rib: A case report. REUMATOLOGIA CLINICA 2019; 15:370-371. [PMID: 28774658 DOI: 10.1016/j.reuma.2017.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 06/27/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Nahia Plaza Aulestia
- Servicio de Reumatología, Hospital Universitario Virgen de Valme, Sevilla, España.
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16
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Abstract
RATIONALE Cervical ribs are rare conditions, occurring in 0.05% to 3.0% of the population. This manuscript reports a case of arterial thoracic outlet syndrome (ATOS) associated with this congenital anomaly. PATIENT CONCERNS We report a 32-year-old female worker presenting pain in her left upper-extremity for 7 months. Her left hand became paler and cold when the temperature decreased, and the symptoms could not be eased through rest, physiotherapy and drugs medication. DIAGNOSES Compression of left subclavian artery with axillary and brachial arteries thrombosis was confirmed by duplex ultrasound and computed tomography angiography. ATOS caused by cervical ribs was confirmed by medical history, physical examination, and imaging. INTERVENTIONS The patients underwent acute thrombolysis and balloon angioplasty. OUTCOMES Symptoms of pain and weakness disappeared after surgery. The patient had not experienced any apparent symptom recurrence at 1-year follow-up. LESSONS Successful treatment of ATOS depends upon urgent assessment, accurate identification of causative factors and compression site and early diagnosis before the event of arterial thrombosis. The surgery combined with anticoagulation treatment can improve the treatment outcome of ATOS.
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Affiliation(s)
- Shuai Jiang
- Department of Hand Surgery, The First Affiliated Hospital
| | - Hui Shen
- Department of Hand Surgery, The First Affiliated Hospital
| | - Wei Qiang Tan
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, PR China
| | - Hui Lu
- Department of Hand Surgery, The First Affiliated Hospital
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17
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Abstract
Thoracic outlet syndrome can present with a wide variety of upper extremity neurovascular symptoms. Timely clinical recognition is essential for prompt treatment and maximal recovery. This article describes a case of thoracic outlet syndrome in a volleyball player with an underlying hypercoagulable state who presented with a subclavian vein thrombosis.
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18
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Incidental findings on cervical spine computed tomography scans: overlooked and unimportant? Neuroradiology 2018; 60:1175-1180. [DOI: 10.1007/s00234-018-2080-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/13/2018] [Indexed: 11/26/2022]
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19
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DeSesso JM, Scialli AR. Bone development in laboratory mammals used in developmental toxicity studies. Birth Defects Res 2018; 110:1157-1187. [PMID: 29921029 DOI: 10.1002/bdr2.1350] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/19/2018] [Accepted: 04/25/2018] [Indexed: 01/12/2023]
Abstract
Evaluation of the skeleton in laboratory animals is a standard component of developmental toxicology testing. Standard methods of performing the evaluation have been established, and modification of the evaluation using imaging technologies is under development. The embryology of the rodent, rabbit, and primate skeleton has been characterized in detail and summarized herein. The rich literature on variations and malformations in skeletal development that can occur in the offspring of normal animals and animals exposed to test articles in toxicology studies is reviewed. These perturbations of skeletal development include ossification delays, alterations in number, shape, and size of ossification centers, and alterations in numbers of ribs and vertebrae. Because the skeleton is undergoing developmental changes at the time fetuses are evaluated in most study designs, transient delays in development can produce apparent findings of abnormal skeletal structure. The determination of whether a finding represents a permanent change in embryo development with adverse consequences for the organism is important in study interpretation. Knowledge of embryological processes and schedules can assist in interpretation of skeletal findings.
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20
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Schut PC, Ten Broek CMA, Cohen-Overbeek TE, Bugiani M, Steegers EAP, Eggink AJ, Galis F. Increased prevalence of abnormal vertebral patterning in fetuses and neonates with trisomy 21. J Matern Fetal Neonatal Med 2018; 32:2280-2286. [PMID: 29353507 DOI: 10.1080/14767058.2018.1431622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess the prevalence of an abnormal number of ribs in a cohort of fetuses and neonates with trisomy 21 and compare this with a subgroup of fetuses without anomalies. MATERIALS AND METHODS Radiographs of 67 deceased fetuses, neonates, and infants that were diagnosed with trisomy 21 were reviewed. Terminations of pregnancy were included. The control group was composed of 107 deceased fetuses, neonates, and infants without known chromosomal abnormalities, structural malformations, infections or placental pathology. Cases in which the number of thoracic ribs or presence of cervical ribs could not be reliably assessed were excluded. The literature concerning vertebral patterning in trisomy 21 cases and healthy subjects was reviewed. RESULTS Absent or rudimentary 12th thoracic ribs were found in 26/54 (48.1%) cases with trisomy 21 and cervical ribs were present in 27/47 (57.4%) cases. This prevalence was significantly higher compared to controls (28/100, 28.0%, Χ2(1) = 6.252, p = .012 and 28/97, 28.9%, Χ2(1) = 10.955, p < .001, respectively). CONCLUSIONS Rudimentary or absent 12th thoracic ribs and cervical ribs are significantly more prevalent in deceased fetuses and infants with trisomy 21.
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Affiliation(s)
- Pauline C Schut
- a Department of Obstetrics and Gynecology , Erasmus MC University Medical Center , Division of Obstetrics and Prenatal Medicine , Rotterdam , The Netherlands
| | | | - Titia E Cohen-Overbeek
- a Department of Obstetrics and Gynecology , Erasmus MC University Medical Center , Division of Obstetrics and Prenatal Medicine , Rotterdam , The Netherlands
| | - Marianna Bugiani
- c Department of Pathology , VU University Medical Centre , Amsterdam , The Netherlands
| | - Eric A P Steegers
- a Department of Obstetrics and Gynecology , Erasmus MC University Medical Center , Division of Obstetrics and Prenatal Medicine , Rotterdam , The Netherlands
| | - Alex J Eggink
- a Department of Obstetrics and Gynecology , Erasmus MC University Medical Center , Division of Obstetrics and Prenatal Medicine , Rotterdam , The Netherlands
| | - Frietson Galis
- b Naturalis Biodiversity Center , Leiden , The Netherlands
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21
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Henry BM, Vikse J, Sanna B, Taterra D, Gomulska M, Pękala PA, Tubbs RS, Tomaszewski KA. Cervical Rib Prevalence and its Association with Thoracic Outlet Syndrome: A Meta-Analysis of 141 Studies with Surgical Considerations. World Neurosurg 2017; 110:e965-e978. [PMID: 29203316 DOI: 10.1016/j.wneu.2017.11.148] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 11/23/2017] [Accepted: 11/25/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cervical ribs (CR) are supernumerary ribs that arise from the seventh cervical vertebra. In the presence of CR, the boundaries of the interscalene triangle can be further constricted and result in neurovascular compression and thoracic outlet syndrome (TOS). The aim of our study was to provide a comprehensive evidence-based assessment of CR prevalence and their association with TOS as well as surgical approach to excision of CR and surgical patients' characteristics. METHODS A thorough search of major electronic databases was conducted to identify any relevant studies. Data on the prevalence, laterality, and side of CR were extracted from the eligible studies for both healthy individuals and patients with TOS. Data on the type of TOS and surgical approach to excision of CR were extracted as well. RESULTS A total of 141 studies (n = 77,924 participants) were included into the meta-analysis. CR was significantly more prevalent in patients with TOS than in healthy individuals, with pooled prevalence estimates of 29.5% and 1.1%, respectively. More than half of the patients had unilateral CR in both the healthy and the TOS group. The analysis showed that 51.3% of the symptomatic patients with CR had vascular TOS, and 48.7% had neurogenic TOS. Most CR were surgically excised in women using a supraclavicular approach. CONCLUSIONS CR ribs are frequent findings in patients with TOS. We recommended counseling asymptomatic patients with incidentally discovered CR on the symptoms of TOS, so that if symptoms develop, the patients can undergo prompt and appropriate workup and treatment.
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Affiliation(s)
- Brandon Michael Henry
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland.
| | - Jens Vikse
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Beatrice Sanna
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Faculty of Medicine and Surgery, University of Cagliari, Monserrato, Italy
| | - Dominik Taterra
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - Martyna Gomulska
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Przemysław A Pękala
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington, USA
| | - Krzysztof A Tomaszewski
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland
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22
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Janák D, Novotný K, Roček M, Rohn V. Thoracic Outlet Syndrome: A Significant Family Genetic Phenotypic Presentation. Prague Med Rep 2017; 117:117-123. [PMID: 27668528 DOI: 10.14712/23362936.2016.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
We report on a very rare case of diagnosis and successful surgical treatment of three young family members with a four-fold presentation of thoracic outlet syndrome. In the relevant family case, we are considering and discussing the population incidence, a possible HOX genes disorder, and a significant phenotypic presentation.
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Affiliation(s)
- David Janák
- Department of Cardiovascular Surgery, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic. .,Institute of Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Karel Novotný
- Department of Cardiovascular Surgery, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Miloslav Roček
- Department of Radiology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Vilém Rohn
- Department of Cardiovascular Surgery, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
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23
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Cantalamessa A, Martin S, Marchegiani A, Fruganti A, Dini F, Tambella AM. Bilateral cervical ribs in a mixed breed dog. J Vet Med Sci 2017; 79:1120-1124. [PMID: 28515371 PMCID: PMC5487793 DOI: 10.1292/jvms.16-0281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A 4-year-old intact female, mixed breed dog was presented with a complaint of dyspnea. Clinical examination revealed symptoms related to disease of the upper airways. Radiographic findings were consistent with tracheal collapse associated with anomalies involving the seventh cervical vertebra and the first ribs bilaterally. Radiographs were highly suggestive of cervical ribs; computed tomography and ultrasound examination allowed complete characterization and better localization of the anomalies with relationship to the adjacent muscle and vasculature. Cervical ribs are malformations widely described in human medicine, but only sporadically in dogs. Herein, we discuss etiological, clinical, diagnostic and therapeutic aspects of cervical ribs and possible correlations between the cervical ribs and other anatomical anomalies noted in this dog.
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Affiliation(s)
- Andrea Cantalamessa
- Veterinary Teaching Hospital, School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione, 93/95, 62024 Matelica, MC, Italy
| | - Stefano Martin
- Veterinary Teaching Hospital, School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione, 93/95, 62024 Matelica, MC, Italy
| | - Andrea Marchegiani
- Veterinary Teaching Hospital, School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione, 93/95, 62024 Matelica, MC, Italy
| | - Alessandro Fruganti
- Veterinary Teaching Hospital, School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione, 93/95, 62024 Matelica, MC, Italy
| | - Fabrizio Dini
- Veterinary Teaching Hospital, School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione, 93/95, 62024 Matelica, MC, Italy
| | - Adolfo Maria Tambella
- Veterinary Teaching Hospital, School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione, 93/95, 62024 Matelica, MC, Italy
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24
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Karapetian MK. Discrete morphological variants of human cervical vertebrae: Exploring pattern of distribution and biological significance. HOMO-JOURNAL OF COMPARATIVE HUMAN BIOLOGY 2017; 68:176-198. [PMID: 28404241 DOI: 10.1016/j.jchb.2017.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 03/04/2017] [Indexed: 10/20/2022]
Abstract
Studies on discrete traits of the human cervical vertebrae, appearing at certain intervals during the last century, posed some questions regarding evolutionary processes that human cervical spine underwent during phylogenesis. To address questions of significance of these morphological traits we need first a good knowledge of the extent of their variation in modern humans. The aim of the current work was to integrate available data on the occurrence of various non-metric traits in the human cervical spine and search for the pattern of their distribution on intra- and inter-population levels. The study was based on data from five osteological samples from North America (Terry and Grant collections) and Russia (mid 20th c. and 18th c.); and data taken from literature. Traits were categorized into rare (<3%), low frequency (up to 10%), often encountered (10-30%) and characteristic for modern humans (>50% on average). Several traits showed mild to strong association with each other indicating interrelation between various spine characteristics. Of the traits analyzed, the following had consistent pattern of sex-related variability: complete dorsal ponticle, bifid spinous processes and cervical ribs; and ancestry-related variability: dorsal ponticle and bifid spinous processes. Each ancestry group (European, African, Asian and North American) had its specifics regarding the latter two traits which might be related to genetic isolation. Most of the traits, however, showed relatively similar pattern of distribution among various populations, including the pattern of within-spine variability. This suggests a common intraspecific pattern and a possible link to some fundamental characteristics of the human vertebral column.
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Affiliation(s)
- M K Karapetian
- Research Institute and Museum of Anthropology, Lomonosov Moscow State University, Moscow 125009, Russia.
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25
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26
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PIOMBINO-MASCALI DARIO, ZINK ALBERTR, PANZER STEPHANIE. Paleopathology in the Piraino mummies as illustrated by X-rays. ANTHROPOL SCI 2017. [DOI: 10.1537/ase.160916] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- DARIO PIOMBINO-MASCALI
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Messina
| | - ALBERT R. ZINK
- European Academy, Institute for Mummies and the Iceman, Bolzano
| | - STEPHANIE PANZER
- Department of Radiology, Trauma Center Murnau, Murnau am Staffelsee
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27
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Adverse Fetal and Neonatal Outcome and an Abnormal Vertebral Pattern: A Systematic Review. Obstet Gynecol Surv 2016; 71:741-750. [DOI: 10.1097/ogx.0000000000000388] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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The Epidemiological, Morphological, and Clinical Aspects of the Cervical Ribs in Humans. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8034613. [PMID: 27975060 PMCID: PMC5126392 DOI: 10.1155/2016/8034613] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 10/04/2016] [Accepted: 10/05/2016] [Indexed: 12/22/2022]
Abstract
A familiarity with the anatomy of some types of bone anomalies is necessary for clinicians involved in many medical areas. The aim of this paper is to review the newest literature concerning the morphology, embryology, clinical image, and therapeutic methods of the cervical ribs in the humans. The incidence of cervical ribs has been found to vary from 0.58% in Malaysian population to 6.2% in Turkish population. Cervical ribs have clinical implications that are generally divided into neurological or vascular. This study is of particular importance for clinicians, as early identification of cervical ribs may prevent life-threatening complications.
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29
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Arányi Z, Csillik A, Böhm J, Schelle T. Ultrasonographic Identification of Fibromuscular Bands Associated with Neurogenic Thoracic Outlet Syndrome: The "Wedge-Sickle" Sign. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2357-2366. [PMID: 27444863 DOI: 10.1016/j.ultrasmedbio.2016.06.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/31/2016] [Accepted: 06/02/2016] [Indexed: 06/06/2023]
Abstract
Thoracic outlet syndrome (TOS) is a disorder characterized by compression of the lower trunk of the brachial plexus, most often in association with anomalous congenital fibromuscular bands in the scalenic region. Early diagnosis is important, because the neurologic deficit associated with TOS may be irreversible. Using high-resolution ultrasound, we investigated 20 consecutive patients with clinical signs suggestive of TOS (all females, average age: 40.4 ± 14.9 y) and 25 control patients. In 19 patients, we identified a hyper-echoic fibromuscular structure at the medial edge of the middle scalene muscle, which indented the lower trunk of the brachial plexus ("wedge-sickle sign"). It was associated with the significant enlargement (p < 0.0001) and hypo-echogenicity of the lower trunk. This novel and distinctive ultrasonographic sign allows pre-surgical identification of anomalous fibromuscular bands causing TOS. It is especially useful in patients without neurologic deficit, in whom the diagnosis may not be as straightforward.
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Affiliation(s)
- Zsuzsanna Arányi
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology, Semmelweis University, Budapest, Hungary.
| | - Anita Csillik
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Josef Böhm
- Neurologische Praxis, Dr. Friedrich Behse/Dr. Josef Böhm, Berlin, Germany
| | - Thomas Schelle
- Department of Neurology, Städtisches Klinikum Dessau, Dessau-Rosslau, Germany
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30
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Ultrasonographic Diagnosis of a Cervical Costa Presenting as a Supraclavicular Mass. Am J Phys Med Rehabil 2016; 96:e11-e12. [PMID: 27149593 DOI: 10.1097/phm.0000000000000523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Moriarty JM, Bandyk DF, Broderick DF, Cornelius RS, Dill KE, Francois CJ, Gerhard-Herman MD, Ginsburg ME, Hanley M, Kalva SP, Kanne JP, Ketai LH, Majdalany BS, Ravenel JG, Roth CJ, Saleh AG, Schenker MP, Mohammed TLH, Rybicki FJ. ACR Appropriateness Criteria Imaging in the Diagnosis of Thoracic Outlet Syndrome. J Am Coll Radiol 2015; 12:438-43. [DOI: 10.1016/j.jacr.2015.01.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 01/23/2015] [Indexed: 10/23/2022]
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32
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Ultrasound-guided supraclavicular brachial plexus block in a patient with a cervical rib. Can J Anaesth 2015; 62:671-3. [PMID: 25663255 DOI: 10.1007/s12630-015-0331-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 01/26/2015] [Indexed: 10/24/2022] Open
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Chandak S, Kumar A. Usefulness of 3D CT in Diagnosis of Cervical Rib Presenting as Supraclavicular Swelling of Short Duration. J Clin Diagn Res 2014; 8:RD01-2. [PMID: 24995230 DOI: 10.7860/jcdr/2014/7977.4374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 03/12/2014] [Indexed: 11/24/2022]
Abstract
This is a unique case of cervical rib since the patient presented as a firm neck swelling of short duration which was clinically palpable as a superficial neck mass and referred for FNAC for the same. Since FNAC did not yield any positive result, the patient was then referred for CT which showed bilateral cervical ribs with pseudoarticulation with the 1(st) thoracic rib on the right side which is quite rare. The clinical importance of our case is to keep in mind a differential diagnosis of cervical rib in firm to hard clinically palpable posterior triangle neck masses. It is also important to diagnose cervical ribs in patients undergoing CT of the neck since they are under reported as determined in previous studies.
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Affiliation(s)
- Shruti Chandak
- Assistant Professor, Department of Radiology, TMMC&RC , Moradabad, Uttar Pradesh, India
| | - Ashutosh Kumar
- Assistant Professor,Department of Pathology, TMMC&RC , Moradabad, Uttar Pradesh, India
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Walden MJ, Adin ME, Visagan R, Viertel VG, Intrapiromkul J, Maluf F, Patel NV, Alluwaimi F, Lin D, Yousem DM. Cervical ribs: identification on MRI and clinical relevance. Clin Imaging 2013; 37:938-41. [PMID: 23759210 DOI: 10.1016/j.clinimag.2013.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 01/03/2013] [Indexed: 11/28/2022]
Abstract
To determine the prevalence of cervical ribs on cervical spine MRI and clinical relevance, we reviewed 2500 studies for cervical ribs and compression of neurovascular structures and compared to CT, when available. Brachial plexus or subclavian artery contact by cervical rib was identified on MRI and/or CT in 12 cases with diagnosis of thoracic outlet syndrome in one. Cervical ribs were identified on 1.2% (25/2083) of examinations, lower than on CT (2%), but MRI may offer equivalent anatomic explanation for patient symptoms.
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Affiliation(s)
- Michael J Walden
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Medical Institutions, Baltimore, MD 21287
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