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JBJS Case Connector, 1922 Oct 01;04(4):687-704
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1. Many cases coming to the orthopaedic surgeon with shoulder trouble may be due to cervical rib.

2. Cases presenting following symptoms: pain, especially on motion, cyanosis, and atrophy of the limb, and no limitation of motion, should make one suspicious of a cervical rib.

3. The fullness of the supraclavicular fossa, besides the x-ray, should help in the diagnosis.

4. The removal of the rib should be practiced by the orthopaedic surgeon for the same reason that he removes the transverse process of last lumbar.

5. Where symptoms have existed over a long period, and especially where paralysis and atrophy form part of the picture, removal of the rib will stop the progressive increase of the symptoms, but may not result in the entire recovery of what has already been lost. This indicates the necessity for early diagnosis, and the desirability of good stereo-radiographs of the neck in every case of persisting pain or lameness of obscure origin.

6. In all cases of shoulder trouble, x-ray of cervical spine should be taken, since, if the cervical rib may not be the sole cause, it may be a contributory cause by interference with the circulation and nerve supply.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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