Conservative Management of Superior Subluxation of the First Rib

Abstract

First rib subluxation is one possible cause of neck, shoulder, and arm pain. The anatomy and biomechanics of the first rib contribute to its tendency to sublux superiorly. Management of first rib subluxation may include manipulative therapy, therapeutic exercises, pharmaceutical agents, and physical modalities to correct joint dysfunction, decrease soft tissue tension, and prevent recurrence.

Superior subluxation of an anterior end of the first rib in a trauma patient

“…To date, the only superior subluxation of the first rib was described at the costovertebral and costotransverse joints 3. The mechanism of an injury involves a force, which is applied posteriorly, which along with the insertion of the scalene medius (acting as a fulcrum) subsequently displaces the rib in an upward direction against clavicle 2–4.…”

“…The affected hypermobile rib can temporarily move out of the anatomical position stretching the ligaments and adding further to the instability 3–5 7. In general, the painful rib syndrome remains under-diagnosed and has been described in a handful of case reports, mainly in athletes.…”

“…Described treatment options include conservative and surgical techniques. The conservative approach includes activity modification, ice packs, non-steroidal anti-inflammatory drugs (NSAIDs) and a physiotherapy 3 5 7 8. Unfortunately, in all the reported cases, conservative management failed and led to surgical resection of the portions of the symptomatic ribs 5 7…”

“…Management of subluxation regardless of the anatomical site includes physiotherapy, therapeutic exercises and NSAIDs 1 3 5. If the conservative approach fails, the surgical option is to excise the affected rib.…”

“Cervicalgia: Check Your First Rib”

“…It is elicitable with local pressure on the rib's head that increases with rotation or flexion of the head and inspiration and expiration. 1 The first rib's head articulates with the body of the first thoracic vertebra via the costovertebral joint, while the costotransverse joint connects the rib's tubercle to the transverse process. 1 The first rib may subluxate due to trauma, repetitive overhead movements and certain sleeping positions.…”