Characterization of a First Thoracic Rib Ligament

Abstract

This previously undescribed ligament is a robust structure, present on at least one side in over 80% of the individuals studied. When present, the ligament creates a narrow interval between the ligament and the first rib that the T1 ventral ramus traverses before crossing the first rib superiorly and contributing to the inferior trunk of the brachial plexus. Although the actual clinical significance has not been demonstrated, this ligament may represent another entrapment site for the T1 ventral ramus.

Double Crush Syndrome of the Upper Extremity

“…The clinical presentation of double crush syndrome varies widely depending on the underlying pathology and levels of compression. Entrapment of the peripheral nerve can cause sensory defi-cits in the affected nerve distribution, muscle weakness, paresthesia, or decreased proprioception 32,33 . Early or moderate cases of double crush syndrome present with a gradual onset of symptoms, including pain or paresthe-sias without electrodiagnostic changes 27 .…”

Middle scalene tendon: a potential pitfall during supraclavicular block

“…The sonographic appearance will vary depending on how the tendon forms within the muscle. Other possibilities based on the structures course and echotexture include variant scalenus minimus tendon attachment, anterior or middle scalene tendons, anomalous first rib ligamentous bands, or suprapleural membrane attachments, many of which have been described as potential pitfalls for supraclavicular blocks 3 4. Notably, prior reports have also described a similar connective tissue structure that separated the T1 and C8 ventral rami, resulting in an anomalous course of the T1 ventral ramus through the supraclavicular fossa 4–6…”