The 1st rib is not just the distant obnoxious uncle you see at reunions, but actually may be the disgruntling next-door neighbor you have to deal with everyday. In conventional terms, it is usually involved in cervical, thoracic, and upper extremity pain more often than you think.
This is not just my opinion, but has been substantiated in the literature over the years via a few sources:
Neck/Upper trapezius pain here
From a surgical standpoint, I wouldn’t delve into resection of the first rib to fix all problems but from our standpoint, its really a no-brainer. We can assess and treat the mobility of the first rib with quite amount of ease.
A detailed anatomy lesson and comprehensive background of this region is outside the scope of this post but can be found elsewhere here and here. In all reality, we assess this region with all of these patients with above complaints but may not think we are assessing the first rib. We should. This post satisfies the latter.
The mobility of the first rib is not that difficult but must be careful that you are actually assessing the mobility of the first rib and not just the awkward trigger points that face the upper trapezius. Be sure you have “peeled” back the fibers from trapezius ridge and feel the mobility, or most likely the lack of. Involvement of the first rib can be assessed through the following:
1. Cervical Rotation Lateral Flexion Test (for elevated first rib in particular)
2. 1st Rib Spring Test Supine (I use it for mobility rather than capability of neurovascular bundles)
I find assessing the joint play in supine to be more effective. The patient seems more relaxed and can actually detect mobility differences side-to-side. Some sources will show it sitting or prone. Also, you can delve right into a treatment approach this way too. Choose what works best for you.
For the sake of shortened discussion here, I did not appraise other problems that are usually present. Simple conclusion is that if one segment is affected, restriction of an adjacent is very expected. Myogenic issues include the scalenes, levator scapulae, pectoralis minor, serratus anterior, etc.; and arthrogenic issues include mobility of the AC joint, SC joint, end-range GH joint, cervical and thoracic spine. As you can imagine, the posts could get as long as a famous Leo Tolstoy novel. Just keep in mind the first rib with dealing with these issues, as I am sure you will not be disappointed in the results.
As always, I’ll entertain your comments and suggestions.