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Elevated 1st Rib Symptoms and Presentation

Updated: Nov 7, 2021

There you are, going about your summer, and suddenly you feel a twinge in your left trapezius muscle, nothing major, but aggravating. As the days go by you feel your left arm feeling weak, and your ring and pinky fingers go numb. "What happened to me?" you ask yourself. "Did I sleep funny?", "I don't remember falling." You go to your PCP, they do a quick evaluation, "It's a muscle spasm" they say. Maybe they take pity on you and prescribe a gentle muscle relaxer. You take it faithfully. Nothing changes. You call your PCP's office back and alert them of the fact that you got little relief. They may send you to get X-Rays. They may send you to orthopedics. In the mean time, you are suffering.

Chances are, you may have an elevated 1st rib. 1st rib, you say? What's that? Anatomy time! Everyone has 12 pairs of ribs. The 1st rib is what's called an "Atypical rib". Ribs 2-10 are considered "Typical Ribs". They are the ones that attach to the sternum. Ribs 11-12 are also "Atypical". The 1st rib is short and thick and attaches to the manubrium, the angled, top part of the sternum. More importantly, it has the groove for the subclavian artery and the lower parts of the brachial plexus. The lower parts of the brachial plexus are the nerves the control the elbow and hand. When the 1st rib becomes elevated or misaligned, it can press up towards the clavicle, and constrict the nerves of the brachial plexus. That explains the weakness and tingling you are feeling in your arm and fingers.

How in the world did I elevate my 1st rib??? Were you involved in a motor vehicle accident, or have a fall, causing your neck to get bent to one side or the other with a lot of force? Do you sleep on your stomach, or sleep with your arm over your head? Do you keep putting the phone between your shoulder and ear for prolonged periods of time during the day? Are you overusing that arm in overhead and/or awkward positions. like a mechanic, electrician, plumber, hairdresser? These are the typical causes of Elevated 1st rib injuries.

"What now?" you say, quoting Butch Coolidge. What now is, you should seek out a qualified physical therapist to perform a full Cervical and Upper Thoracic Spine evaluation on you. At Physical Therapy of Woburn, our PT staff is trained to assess your Cervical and Thoracic spine alignment, test your muscle strength, measure your range of motion and perform the special tests needed to determine if your 1st rib is elevated. If it is found that, yes, it is elevated, you will be placed in a specialized physical therapy program that will focus on using manual techniques to correct the 1st rib. Following that you will be taught a stretching program aimed at loosening the Scalene muscles, Trapezius Muscles, and Levator muscles. You will also be placed in a strengthening program to restore the muscles of the neck, shoulder, elbow, arm and fingers.

The first few visits may be uncomfortable as the swelling on the trapezius is worked on and the 1st rib is gradually manipulated into place. Once corrected, you will be taught strategies to keep the 1st rib from potentially re-elevating. Our program incorporates a lot of stretching, resistance exercises and postural awareness. Our philosophy is the stronger the trapezius and upper thoracic muscles are, the better chance of recovery. Taping of the Trapezius and Cervical spine may also be included in the program.

If you feel like you are experiencing any of the above symptoms, chances are you may have an elevated 1st rib. As always, we recommend you follow up with your PCP and see if you are a candidate to receive physical therapy. If you do not have a PCP, give us a call and we can do our best to assess you situation.

As always, we at Physical Therapy of Woburn, will work with your physician's office to expedite referrals, authorizations and PT orders. The above information should not be considered medical advice. It is for reference only.

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