Prospective Case Study in Treatment of Cervical Rib at C4 Vertebra

Background: Cervical rib is a rare congenital anomaly, usually from C7. Most are asymptomatic, but incomplete ribs can compress neurovascular structures, especially the brachial plexus, causing pain, paresthesia, and weakness. This case reports a 19-year-old male with a rare CR at C4, presenting with severe right-sided neck and shoulder pain, tingling, and functional limits after prolonged backpack use. Diagnosis was confirmed via X-ray.

Purpose: To evaluate whether a non-surgical, evidence-based physiotherapy program could reduce pain and improve function in a patient with a rare symptomatic cervical rib.

Method: A qualitative case study was conducted. Assessment included muscle strength, shoulder range of motion, nerve tension tests (ULTTs), and special tests (Adson’s, Roos). The baseline Numeric Pain Rating Scale (NPRS) was 8/10; the Neck Disability Index (NDI) was 34 (severe).

Intervention: Weeks 1–2: Neural mobilization (median, ulnar nerves) and ultrasound therapy (3 MHz, 2 W/cm², 4 days/week) → NPRS reduced to 6; NDI to 26. Weeks 3–4: Neural mobilization plus Muscle Energy Techniques (scalenes, upper trapezius) → NPRS 2; NDI 20. Weeks 5–6: Maintenance sessions (3 days/week) sustained improvements.

Results: Pain and functional scores improved steadily: NPRS from 8 to 2; NDI from 34 to 20 by Week 4, maintained through Week 6.

Limitation: Single-subject design limits generalizability. No long-term follow-up to assess sustained benefits.

Conclusion: A non-surgical, phased physiotherapy program—combining neural mobilization, ultrasound therapy, and muscle energy techniques—effectively reduced symptoms and disability in a rare high-level cervical rib case.