Background: Cervical rib, though it is seen incidentally in the radiographic examination of chest and cervical spine, a particular subset of it can present with thoracic outlet syndrome. This article mainly focuses on the symptom causation of articulating cervical rib, as compared to non-articulating cervical rib which is often asymptomatic. There are many articles describing a cervical rib, but those highlighting this particular relation between the types of cervical rib and symptom causation are not present in present database. The review of serial radiographs upon correlating clinically, lead us to conclude that articulating variant of cervical rib is majorly symptomatic and caused grave arterial complications. The article consists brief discussions on the types of cervical ribs, thoracic outlet syndrome and role of imaging in diagnosing a cervical rib. Main Body: We have illustrated five such cases from our tertiary care hospital and highlighted the relationship between the magnitude of symptoms and variations of cervical rib. In compliance with PRISMA guidelines, we screened 33 articles dealing with cervical rib and 13 with thoracic outlet syndrome. Overall, 46 articles were filtered on studying the abstract. Further, 15 more had to be excluded as they were case reports and case series, and finally 31 articles were included in our study. We studied and discussed these articles and research papers in relation to variant anatomy of cervical rib, its types and symptom causation. In our study, also routine sequential chest radiographs were reviewed during the period of January 2020 to January 2021 and those with cervical rib and/or elongated C7 transverse process were included. Conclusion: Thus, to conclude we can state that articulating cervical ribs pose a greater threat and cause arterial occlusion. Key words: Cervical rib, thoracic outlet syndrome, subclavian artery.