Int J Anat Res 2013, 03:152-54. ISSN 2321-4287
Case Report
SYNOSTOSIS OF FIRST COSTOM ANUBRIAL JOINT
J.Ratnapriyanka
1, Pradeep Kumar H M urudkar
2, Ravindra Kumar Boddeti
3,
Ashwini
4, Nazeer Ahmed
5.
ABSTRACT
Address for Correspondence: M s.J.Rat napr iyanka, Tut or, Depar t m ent of Anat om y, Khaja Band an aw az In st i t u t e o f M edi cal Scien ces (KBNIM S), Gu l bar ga, Kar n at aka, In di a.
E-M ail: priyarat [email protected]
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1,2,4,5 Depart ment of Anat omy, Khaja Bandanawaz Inst it ute of M edical Sciences, Gulbarga, Karnataka,
India.
3 Lect urer, Depart ment of Anat omy, IM S, M anagement & Science Universit y, M alaysia.
The rare congenit al anom aly of r ibs w as found incidentally during rout ine ost eology classes. This t ype of abnorm alit y of first rib M ay leads t o com pression of Neurovascular bund le and causes t horacic out let syndrom e.
We are repor t ing a case of Synost osis of first rib, w hich w e com e across during ost eology classes at Depart m ent of Anat omy, KBNIM S, Gulbarga, Karnataka, India. The specim en show ed fusion of first ri b w it h st ernum on bot h sides w hich is very rare. As far as t he lit erat ure refer red t here w as no such kind of anom aly report ed. Know ledge of such anom alies is an im portant t o know, especially for surgeons and radiologist s for int erpretat ion.
KEYW ORDS:First Rib Fusion; Synost osis; Cost om anubrial; Supernum ery Ribs; Cervical Rib.
INTRODUCTION
Int ernat ional Journal of Anatomy and Research,
Int J Anat Res 2013, Vol 1(3):152-54. ISSN 2321- 4287
Received: 19 Sep 2013
Peer Review : 19 Sep 2013 Published (O):30 Dec 2013 Accepted: 20 Nov 2013 Published (P):30 Dec 2013
Internat ional Journal of Anat omy and Research ISSN 2321-4287
w w w.ijmhr.org/ ijar.ht m
152 A bony joint , or Synost osis (SIN-oss-TOE-sis), is
an immobile joint formed when t he gap bet ween t w o bones ossifies and t hey become, in effect , a single bone. Bony joint s can form by ossificat ion of eit her fi brous or cart ilaginous joint s. For exam ple, An infant is born w it h right and left frontal and mandibular bones, but t hese soon fuse seamlessly t o form single bones. In old age, som e cranial sut ures becom e oblit erat ed by ossificat ion, and t he adjacent cranial bones, such as t he parietal bones fuse. The epiphyses and diaphyses of t he long bones are j oined by car t i lagi no u s j o i nt s in chi l d ho o d an d adolescence, and t hese become synost osis in early adult hood. The attachment of t he first rib t o t he sternum also becomes a synost osis w it h age [1].
Co ngen it al r i b d ef ect s ar e cl assi f ied in t o Num erical and st ruct ural defect s. Numerical defect s include supernumerary ribs i.e. cervical,
lumbar, Pelvic or sacral ribs and 11 pairs of ribs found in Dow n syndrom e and t he st ruct ural defect s of ribs include Short rib , bifid rib or f o r ked r i b , f u sed or b r i d ged r i b s, an d pseudoart hrosis of first rib. [2](Fig. 1).
An at o m ical ly i n b et w een t h e 1st r i b an d manubrium present s t he Sychondrosis (a t ype of hyaline car t ilage) is t he j oint , ot herw ise referred t o as t he first sternocostal joint . This t ype of joint also found in t he epiphyseal plates of long bones prior t o fusion [3].
CASE REPORT
Int J Anat Res 2013, 03:152-54. ISSN 2321-4287 153 DISCUSSION
Cost o-chondral anomalies at t he upper end of t horacic cage are may be due t o defect s in t he segm en t at i on of b ony t i ssue du r i ng ear ly developm ent of t he life and m ay it m ay be associated w it h variat ions in t he disposit ion of neuro-vascular st ruct ures [4].
Literature review show ing t hat t here w ere many reported cases over t he first rib anomalies w hich include t he float ing rib, cent ral defect s bridged by ligament ous bands, rudimentary st ruct ure terminat ing in a synost osis or pseudoart hrosis w i t h seco n d r i b, b if u r cat ed f i rst r i b , Sternocost oclavicular hyperost osis etc. [5].
After t he t horough search in t he literat ure and an at o m ical r ecor d s t h ere w er e ver y f ew Unilat eral and bilat erally cases of synost osis w ere reported but t here w ill be no documentary evidence for it , The anat omical report s on t he fusion of ribs described first rib as a rudimentary st ruct ure forming synostosis w it h t he second rib [6,7,8,9,10].
In t he present st udy, t he fused first rib was of normal caliber and fused w it h t he sternum at t he usual site (Fig. 2).
While compared w it h t he ot her species first rib inst ead of form ing a synost osis m ay rem ain float ing in soft t issue similar t o t hose found in birds [9], or may be connected by a ligament ous band w it h t he sternum [4,10].
Few clinical st udies reported t hat neurological sympt oms and vasomot or changes of Thoracic out let syndrome (TOS) could be at t ributed t o broad attachment of scalenus medius muscle [5,10,11].
Compression of neurovascular st ruct ures may occur w hile passing from neck t o axilla t hrough a narrow interval bet w een scalenus anterior, hypert rophied scalenus m edius and first rib [10,11].
First rib malformat ions such as rudimentary rib, fused ribs are commonly associated w it h post fixed brachial plexus w it h a large cont ribut ion f ro m second t hor acic ner v e [ 5,9,10] . The cont ribut ion of second t horacic nerve may cause ext ra pressure on t he groove [5,10].
Rib fusion w it h t he m anubr ium m ay causes scoliosis and rest rict ion of chest wall expansion [12,13], w hich may require surgical interventions t o relieve t he sympt oms.
Fig. 1:Types of fusion anom alies of Thoracic ri bs. (a) Bicipital ri b (b) Br idged rib (c) Forked rib
(a) (b) (c)
Aw areness and precise know ledge about t he skeletal abnormalit ies especially t horacic cage has an important clinical significance as it s plays vital role in t he respirat ory movement besides t he academic interest .
CONCLUSION
Int J Anat Res 2013, 03:152-54. ISSN 2321-4287 154 J.Rat napriyanka et al., Synost osis of First Cost omanubrial Joint .
Conflicts of Interests: None
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