Question Title: extra rib / carpal tunnel symptoms

Forum: Neurology Forum
Topic: Pain

Posted by CCF Neurology MD on October 21, 1997 at 19:33:37:

In Reply to: extra rib / carpal tunnel symptoms posted by Lydia on October 09, 1997 at 04:06:58:

: I have symptoms of Carpal Tunnel Syndrome in my left hand and arm.
An EMG confirmed, however, that I do not have CTS. A physician said that
the pain and numbness in my arm, wrist and fingers may be the result of
an extra rib (of which I have two) pressing against my clavicle and
compressing the nerve. Is this reasonable? If so, how can this be treated?

Dear Lydia:

Hand symptoms of pain, numbness, and even weakness can indeed, at times, result from the "extra" (cervical) ribs that you describe. This condition is called the neurogenic thoracic outlet syndrome. More commonly, such symptoms result from the carpal tunnel syndrome (pinching of the median nerve at the wrist), cervical radiculopathy (pinching of a nerve root(s) at the level of the spine), or ulnar neuropathy (usually at the level of the elbow).
An appropriately tailored EMG examination performed in a reputed laboratory by a neurologist with expertise in neuromuscular disease can very accurately diagnose (or exclude) each of the four conditions I mention.
Surgery (correctly performed) is the treatment of choice for the neurogenic TOS. Inappropriately indicated or incorrectly performed surgery for neurogenic TOS can be quite dangerous and may even result in permanent nerve damage.
In case you live near Cleveland and wish to have a second opinion (which, I think, is indicated if surgery is being considered), I very strongly recommend that you have an evaluation from Dr. Asa Wilbourn at the Cleveland Clinic. Dr. Wilbourn is an internationally renowned expert on neurogenic TOS.
Good luck!

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