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The cervical rib

A PREDISPOSING FACTOR FOR OBSTETRIC BRACHIAL PLEXUS LESIONS

¹ Clinic for Plastic and Hand Surgery, University of Witten-Herdecke, Klinikum Wuppertal, Arrenbergerstrasse 20, D-42117 Wuppertal, Germany.
² Clinic for Plastic Surgery, Hand and Burn Surgery, RWTH Aachen, Pauwelstrasse 30, D-52074 Aachen, Germany.
³ Plastic Surgery, Franziskus-Hospital Aachen, Morillenhang 27, D-52074 Aachen, Germany.

Correspondence should be sent to Dr M. H.-J. Becker.

Controversy surrounds the aetiology of obstetric brachial plexus lesions. Most authors consider that it is caused by traction or compression of the brachial plexus during delivery. Some patients, however, present without a history of major traction during delivery, and some delivered by Caesarean section also suffer the injury.

In our series of 42 infants, 28 had an Erb’s palsy, and the remaining 14 presented with a more extensive lesion, involving the lower roots. In five of these, a complete ossified cervical rib was found.

We believe that anatomical variations, such as cervical ribs or fibrous bands, can cause narrowing of the supracostoclavicular space, and render the adjacent nerves more susceptible to external trauma.