Dr. Allan Horowitz, published newspaper article, Richmond Hill Liberal, Copyright May 20, 1987     

QUESTION: Have you ever heard of someone having one extra rib in their chest? I was having pain in my shoulder and arm so I went to a friend’s chiropractor. He treated me for a while but when I didn’t get better he took x-rays of my shoulder and neck. He then told me my pain was being caused by pressure on my nerves caused by having one extra rib.

He said it was a rare condition but that he couldn’t really help me except give me some special exercises to try to take the pressure off my nerves. He also told me that if my pain gets any worse I will have to have the rib taken out by a surgeon. How rare is this extra rib, and is there anything else that can be done?

ANSWER: Despite what you may have learned in Sunday School, men and women both have 12 pairs of ribs. The ribs attach in front to the sternum and in back to the spinal bones. The upper few ribs are very small and curved because they don’t’ have a great distance to travel from front to back, while the ribs in the middle of the chest are very long and more flattened.

Sometimes an extra rib grows above the first rib. It is usually very small and usually attaches to the last spinal bone in the neck. Sometimes it grows on both sides, while sometimes it is only on one side. Often it is sized and shaped differently on different sides.

One source I consulted stated that these ‘extra’ ribs occur on both sides in 66 percent of all cases. The same source stated that these ribs are twice as common in females and that the incidence in the normal population is 0.5 percent; in other words, one out of every 200 people will have an extra rib. You happened to be one in 200.

The medical name for these ‘extra’ ribs is cervical ribs, because they normally are found in the cervical spine. They are considered to be a congenital anomaly or something that just developed in an unusual way from birth. They are not the result of trauma, abuse or bad living. There is nothing you can do to prevent them from occurring.

The symptoms from a cervical rib are usually consistent with alteration of the normal nerve or vascular flow from the neck into the arm. This means that the nerves and/or blood vessel are being pinched by the rib or tissue around the rib.

This will lead to neck, shoulder, arm, or hand tingling, numbness, burning, pain, weakness, coldness or fatigue. The size of the cervical rib usually doesn’t have any bearing on the degree of pain.

Treatment of the problem involves finding the area of neurovascular compression and trying to alleviate the pressure. Exercises to strengthen the shoulders and neck, exercises to increase the lower neck flexibility, posture training, decreasing rounding of the shoulders, losing weight if obese and correcting poor sleep habits are all important in helping this condition.

Usually a few weeks is necessary to relieve the pressure if the patient follows all of the instructions they are given. The problem is notorious for coming back time after time if the exercises and posture corrections are not maintained. In cases where therapy doesn’t work, surgery may be performed to remove the rib. This of course is only used as a last resort.

I think you should listen very carefully to your chiropractor’s instructions and follow through with everything he tells you. As you get older or less physically fit, your condition will worsen unless you take positive steps to help yourself now.