Case Study:
Cervical Rib Syndrome
Sarah, who is 26, noticed that over a period of time she experienced pain, tingling, and
numbness in the ring finger and little finger of her right hand. She also had pain in her elbow,
which radiated down the anterolateral portion of her forearm and hand. She made an
appointment with her physician. After careful examination of Sarah's upper limb, her physician
ordered an X-ray of her neck. The X-ray disclosed a cervical rib on the right, which was
attached to the C7 vertebra. Cervical ribs are not uncommon, occurring in about 1% of the
population. Most people exhibit no symptoms, but symptoms may develop in some people. If
the extra rib compresses the inferior roots of the brachial plexus, the condition is called cervical
rib syndrome- one of several thoracic outlet syndromes. An alternative thoracic outlet syndrome
may involve the brachial artery rather than the brachial plexus.
Questions:
1. Name the brachial plexus nerve supplying the skin of the hand.
2. Damage to which of these nerves could produce the symptoms seen in Sarah's hand?
3. What made Sarah's physician suspect rib syndrome rather than damage to an individual
nerve?
4. Cervical rib syndrome can also affect muscles, producing muscle weakness and paralysis.
What muscles supplied by these nerves could be affected by a cervical rib?