Pain when pulling upper limbs and shoulders down or holding heavy objects



The most common first symptom of the neck rib is hand and shoulder dull pain, which is intermittent. Pain increases when the upper limbs and shoulders are pulled down, or when heavy objects are held in hand. The neck rib is a congenital deformed rib that can be caused by trauma, shoulder weight factors, and the like.



(1) Causes of the disease

The causes of neck ribs are trauma, shoulder weight, periostitis, shoulder sag, first rib deformity, anterior scale muscle hypertrophy, abnormal fiber band and so on.

(two) pathogenesis

Anatomically, the brachial plexus and the subclavian artery pass through a triangular gap formed by the anterior scalene muscle, the middle scalene muscle, and the upper edge of the first rib, into the ankle, and the lower group of the brachial plexus is located behind the subclavian artery. Both form a bundle of neurovascular vessels. The cervical rib is more common in the seventh cervical vertebra, and sometimes also in the sixth cervical vertebra, and its length varies. Generally, according to the shape of the neck rib, it is divided into 4 types: type I, the neck rib is short, just beyond the transverse process, and generally no compression symptoms appear. Type II, the neck ribs are more than the transverse process, the ends are free and can directly resist or compress the brachial plexus. Sometimes the fiber band is attached to the first rib, which compresses the brachial plexus. Type III, the neck ribs are almost intact, and the fiber band is connected to the first costal cartilage, and the brachial plexus and the subclavian artery are often pressed. Type IV, the neck rib is intact, and the costal cartilage is connected to the first costal cartilage, and the brachial plexus and the subclavian artery and vein are often compressed.


an examination

Related inspection

X-ray palpation X-ray lipiodol CT examination

Most neck ribs have no symptoms and only show symptoms when blood vessels and nerves are squeezed. The general sign of the disease is that the patient's shoulder is full of muscles, the supraclavicular fossa is shallow, and sometimes the raised mass or the hypertrophic scalene can be reached. In addition, it is divided into three types according to the components involved.

Neurological type

(1) Hand and shoulder dull pain are the most common first symptoms and are intermittent. When the upper limbs and shoulders are pulled down, or the weight is aggravated when holding heavy objects, the patient often lifts the upper limbs above the head. Muscle strength, which is dominated by the VIII cervical nerve and the first thoracic nerve, is manifested in grip, pinching, and small movements. In the late stage, the intermuscular muscles and the size of the inter-muscular muscles are atrophied, and the innocent reflex changes. The sensory disorder is dominated by the ulnar nerve distribution area.

(2) Due to sympathetic nerve compression, vasomotor dysfunction occurs, such as skin discoloration when the hand is drooping, grayish blue, sweating, edema, and disappear after lifting. When the cold finger turns pale. Sometimes cervical sympathetic paralysis syndrome (Horner's syndrome).

(3) The neck ribs are sometimes tactile, and compression can cause local pain and radiate to the arm.

2. Vascular type: less, intermittent upper limb skin color change or venous engorgement, severe ulceration or gangrene, accompanied by pain or pain disorder. It is an important sign that the clavicle can often hear the murmur. Sometimes it can be heard on both sides, and the affected side is loud. The above symptoms are aggravated by traction of the upper limbs. Anterior scale muscle test (Adson test): Take the sitting position, the arm naturally hangs down, the head is forced to turn to the diseased side and then stretched, the deep inhalation and breath holding, the sick side radial artery beat weakened or disappeared, positive.

3. Neurovascular type: refers to a case of mixed neurological and vascular types.

Middle-aged patients, especially female patients, who have the above clinical manifestations should be suspected of the disease and further X-ray examination. Sometimes the X-ray film does not find the presence of neck ribs, but there may be abnormal fiber bundles causing compression.


Differential diagnosis

Sudden swelling and soreness in the upper limbs: one of the symptoms of deep vein thrombosis in the upper extremities. Upper extremity swelling is the earliest symptom that extends from the finger to the upper arm to the entire upper limb, and is more severe in the proximal side. Pain can occur at the same time as swelling, or it can only manifest as soreness, increased in the upper limbs, and sometimes in the form of a cord-like, tender thrombus. About 2/3 of the patients had venous congestion and the affected limbs changed in purple or blue-purple.

Stinging or numbness in the fingers or arms: Patients with cervical spinal stenosis complained that there are fingers (mostly at the fingertips) or pain and numbness in the arm when the disease is first developed, especially tingling.

Hand grip is weak: mainly when there is no power when holding the object. Hand nerve compression syndrome, pre-spinal syndrome, cervical spondylosis, tennis elbow and other diseases can cause hand grip weakness.

Pain in the shoulder: due to visceral disease, causing shoulder pain, or hyperalgesia, known as suffering. Symptoms appear to be slow, dull, or uncomfortable. They do not completely conform to the nerve direction, the area is blurred, and the pain is blurred.

Heavy shoulder and back: heavy shoulder and back, upper limb weakness, finger numbness, limb skin sensation, etc. are clinical manifestations of cervical spondylosis.

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