Anatomy of Cervical Rib and Its Effects

Study Notes

May have a blind tip or be connected to the 1st rib by fibrous band, cartilage, or bone
Compresses the lower trunk of the brachial plexus and subclavian artery
Compression produces:
- Pain along the medial side of the forearm and hand
- Disturbance in the circulation of the upper limb
- May cause Thoracic Outlet Syndrome

Paralysis can occur due to injury to the phrenic nerve
Paralysis of one half does not affect the other half due to separate nerve supply
On X-ray, the paralyzed dome shows paradoxical movement:
- Instead of descending on inspiration, it is pushed superiorly by abdominal viscera
- Descends during expiration due to positive pressure in the lungs

Occur due to involuntary spasmodic contractions of the diaphragm accompanied by the closure of the glottis
Normally occur after eating or drinking due to gastric irritation
Pathological causes include:
- Diaphragmatic irritation
- Phrenic nerve irritation
- Hysteria
- Uremia

Occurs due to severe blunt trauma (e.g., serious fall, car accident)
Portion of rib cage is separated from rest of chest wall (multiple rib fractures)
Injured region of the chest wall moves paradoxically:
- Inward during inspiration
- Outward during expiration
Common site of fracture: Middle ribs
Weakest part of ribs: Just anterior to the angle
Condition is painful and may cause difficulty in ventilation, leading to reduced oxygenation

One of the most common cancers in females
Arises from epithelial cells of lactiferous ducts
More frequently seen in postmenopausal females due to lack of estrogen hormones
Clinically presents as:
- Painless hard lump
- Breast becomes fixed and immobile due to infiltration of suspensory ligaments
- Skin retraction due to infiltration of suspensory ligaments
- Retraction of nipple due to infiltration and fibrosis of lactiferous ducts
- Prominent or "puffy" skin (peau d'orange appearance)
Obstruction of superficial lymph vessels by cancer cells may produce edema of the skin

Lymph vessels from the inferomedial quadrant of the breast communicate with the sub-peritoneal lymph plexus
Cancer cells migrate trans-coelomically and deposit on the ovary, producing a secondary tumor in the ovary called Krukenberg's tumor

Radical mastectomy involves removing the whole breast, pectoral muscles, fat, fascia, and as many lymph nodes as possible in the axilla and pectoral region
Risks during radical mastectomy:
- Lesioning of the long thoracic nerve during ligation of the lateral thoracic artery
- Damage to the intercostobrachial nerve (lateral cutaneous branch of the second intercostal nerve), resulting in skin deficit of the medial arm