Cervical edges

Description:

During primary segmentation of a mesenchyma embryos of the person have 29 pairs of edges. Further only 12 chest couples develop, and the others are exposed to involution. Cervical edges as anomaly of development form owing to disturbance of processes of a reduction of their rudiments. As processes of involution of cervical edges happen gradually, from cranial department to caudal, they are observed preferential on Cvi-Cvn.

Pathogeny:

According to G. Gruber, distinguish true and false cervical edges. The true cervical edge is presented by a head, a neck, a body and connects to a cross shoot a costovertebral joint. At false cervical edges the edge body joint with a cross shoot in the form of a syndesmosis or a synostosis is noted.

Distinguish also full and incomplete cervical edges. Full cervical edges resemble the real edge superficially and at localization on C V I I connect to the I chest edge by means of a tyazh, a syndesmosis or a synostosis. The incomplete cervical edge freely comes to an end in soft tissues, and in rare instances its end connects to the I chest edge by means of a fibrous tyazh. Cervical edges need to be distinguished from hypertrophied cross shoots of cervical vertebrae.

At the considerable sizes cervical edges change neck anatomy. The brachial plexus of the ends of an incomplete edge or fibrous tyazhy is displaced kpered, and in the presence of a full edge is located over it. The subclavial artery together with a brachial plexus can be displaced kpered. At a full cervical edge the subclavial artery is located over it therefore length of an artery and a corner of its bend over an additional cervical edge increase.

Front and average scalenes are attached or to a cervical edge, or to the I edge, or to both. In some cases narrowing of an interladder interval, existence of a set tyazhy in this area are noted. The back scalene is attached to the II edge.

Cervical edges meet equally equally from one or both parties, is much more often at women, than at men, about 85:15.

Symptoms of cervical edges:

The clinical picture of a disease is defined by the number of edges, their length and the relation to a neurovascular bunch. More than at 90% of patients the asymptomatic current is noted, and cervical edges find as a find at radiological inspection of patients. Sometimes in supraclavicular area the ends of cervical edges are visible контурирующиеся under skin. In these cases painless or moderately painful tumorous formation of a bone consistence is palpated. Outward of the patient at multiple cervical edges is described by V. P. Manuylov: the neck is thickened, has a cone-shaped (tyulenepodobny) appearance, shoulders are lowered and represent as if continuation of a neck.

At the prevailing most of patients the brachial plexus and a subclavial artery in an interladder interval are located freely, and at less than 10% of patients there is a prelum of a neurovascular bunch a cervical edge or fibrous tyazhy. In these cases the so-called compression syndrome develops. Secondary, but not less important role in development of a compression syndrome is played by a hypertrophy and a spasm of a front scalene. On the basis of clinical observations it is established that at full cervical edges symptoms of disturbance of blood circulation in an extremity owing to a prelum of a subclavial artery prevail, and at incomplete edges the neurologic symptomatology prevails. In the majority of observations the combination of neurologic and vascular disorders meets.

Pain - the most characteristic and constant symptom. Pain develops preferential after exercise stresses, at turn of the head, a neck inclination, a hand raising, omission of a shoulder and a shoulder girdle. It can be local acute or widespread. The pain syndrome is localized preferential in a zone of an innervation of an elbow nerve, but sometimes extends to a shoulder, a shoulder girdle, occipital area. The hyperesthesia, a giposteziya, anesthesia which are most expressed in a zone of an innervation of elbow and beam nerves are characteristic.

Disturbances of blood circulation are connected with disturbance of a blood-groove in a subclavial artery and its branches and can vary from moderate decrease in pulse wave on a beam artery to extremity gangrene. Owing to the edge pressure upon a subclavial artery various pathological changes can develop. With a constant pressure of an edge upon a vascular wall its traumatic damage with development of atheromatous changes of a vascular wall is noted. Disturbance of a trophicity of a vascular wall and organic changes are the contributing factor to development of thrombosis of a subclavial artery. In some cases irritations of sympathetic trunks result a spasm of vasa vasorum, their fibrinferments that leads to disturbance of a trophicity of a vascular wall on a considerable extent and to development of spindle-shaped aneurism in a distal third of a subclavial artery.

At a prelum of a subclavial artery of various degree patients cannot work with the raised hands, lift weights, drive the car. Organic changes of a subclavial artery and its terminal departments are shown in the form of hypostasis, cyanosis of an extremity, gangrene of fingers.

The irritation of trunks and dysfunction of the autonomic nervous system are shown by preferential vasculomotor disturbances. Skin is cold, sweating is increased. On the party of defeat Bernard-Horner's symptom often meets.

Adson described the test for identification of a prelum of a subclavial artery. The patient sitting takes a deep breath, raises a chin and turns the head towards defeat. Holds hands on a lap. Decrease in pulse, change of pressure are pathognomonic signs of a prelum of an artery.

Cervical edges and hypertrophied cross shoots can be the cause of development of a syndrome of a scalene at which there is a prelum in an interladder interval of a subclavial artery, a brachial plexus, the fibers of the autonomic nervous system going as a part of a brachial plexus and located around a subclavial artery.

Treatment of cervical edges:

In more than 90% of cases cervical edges are a radiological find and do not demand any special method of treatment. In doubtful cases, and also at emergence of clinic of a syndrome of a front scalene carry out conservative treatment which includes rest creation to a neck, надплечыо, an upper extremity, improvement of a krovoobrayoshcheniye, scalene spasmolysis, the therapy directed to a rassasyvaniye of Cicatricial fabrics. The favorable effect can be gained from infiltration by novocaine of the place of an attachment of a front scalene, and also novocainic blockade of necks - a but-chest (star-shaped)  node.

Apply Shants's collar, soft bandages fixing an upper extremity to an immobilization. Appoint vasodilators (Dibazolum, Nicospanum, компламин), physiotherapeutic treatment (an electrophoresis of novocaine, a lidaza, potassium iodide), massage, remedial gymnastics.

In the presence of the symptoms caused by a prelum of a neurovascular bunch cervical edges, effect of conservative treatment doubtful.

Surgical treatment. The indication for a resection radiological of the identified additional cervical edge are signs of a prelum of a neurovascular bunch at the positive vascular test of Adson. The cervical edge is deleted from front or back accesses.

Removal of an additional cervical edge from front  access. Carry out a section of soft tissues 2 cm higher than a clavicle and parallel to it 10 cm long. Cross a lateral head грудино - a clavicular and mastoidal muscle, cut a scapular and hypoglossal muscle. Bare a front scalene and the phrenic nerve passing over it. The nerve and a medial head грудино - a clavicular and mastoidal muscle are taken away by knutr, and the brachial plexus is taken away by knaruzh. Tie up, and then cross a cross artery of a neck and a nadlopatochny artery. Further lift the probe and cross a front scalene, as a result bare the subclavial artery lying under it. The artery a rubber strip is taken away by kpered and from top to bottom then bare the I edge and the additional cervical edge which grew together with it or only сопри­касающееся. The additional cervical edge is deleted with parts together with a periosteum Lyuer's nippers. The wound is layer-by-layer sewn up.

Removal of an additional cervical edge from back access. The patient lies on a stomach. Carry out a juxtaspinal section 10 cm by 2 cm long lateralny acanthas. At the level of CVII stratify muscles, allocate cross shoots of Cvi and Cvii and resect their nippers Lyuer. Capture by Kostoderzhatel an additional edge and, accurately separating soft tissues, delete it together with a periosteum.

Section of a front scalene. Adson offered crossing of a front scalene instead of removal of an additional cervical edge. Further he recommended to delete a part of a full edge for mobilization and elimination of the injuring factor, to excise the lower part of a front scalene and to resect all abnormal educations squeezing a brachial plexus. At domination of vasculomotor frustration operation is supplemented with a sympathectomy of a sheynogrudny node or a periarterial sympathectomy.

The section and access to a front scalene do not differ from those at front access to an additional cervical edge. After crossing of a tendinous part of a front scalene at the place of an attachment to an edge small pieces excise its lower part and release the squeezed subclavial artery. In case of an union of a subclavial artery with a brachial plexus of commissure between them cut. If the front scalene is hypertrophied, it is excised throughout 5 cm proksimalny the free end.

In the presence of a full cervical edge a part it is deleted with Lyuer's nippers. For this purpose displace the lower trunk of a brachial plexus down, and an average trunk - up. Before mending of a wound of Adson recommends to place a piece of fatty tissue between a subclavial artery and a brachial plexus for the prevention of their scarring.

Noose sutures sew a lateral head грудино - a clavicular and mastoidal muscle and a dissect scapular and hypoglossal muscle.

Operation in most cases allows to receive good result.