Pain in the neck? It could be an elevated First Rib

[Updated on 1 June 2020] The first rib is the most superior of all the twelve ribs. It’s the first true rib that is located at the top of your chest. The First ribs sit right below your collarbone, and it is normally held in place by a series of supporting muscles. It’s ideally, one of the borders of the superior thoracic aperture.

FirstTrueUpperRibThe human ribs are what create the thoracic cage structure, and that is what guards the thoracic organs. The intercostal space is supported by 12 pairs of ribs. The first of the seven ribs will progressively increase in length, while the remaining five ribs at the bottom decrease in length. The human ribs are highly trabecular and vascular and have thin outer layers with a compact bone. These are very similar to the first rib. It’s important to note that the 11th and 12th ribs are normally considered atypical ribs due to the anatomical features they have. The remainder of the ribs are atypical.

From the top, the first rib is normally held on position with the scalene muscles that normally run up from the side of your neck. They naturally pull the rib upwards. The intercostal muscles that are located between the ribs in opposition work by pulling the rib down. Therefore, there is a balance that is needed between these two muscles to keep the rib in its proper position. When there is an imbalance, there is a possibility that the position of the first rib will shift.

What is the Elevated First Rib?

This condition normally occurs when the rib moves up and out of its proper alignment. And in physical terms, this motion can cause excruciating pain from the misalignment, which in effect squashes quite several veins, nerves, and arteries that are located between the first rib and your collarbone. A nerve bundle is known as the brachial plexus that is responsible for sending the sensation to your hand and arm as well as through your arteries and veins that feed the arm pass directly over the first rib under your collar bone. The main problem normally occurs when the first rib is locked in this position.

The other possible method in which the elevated first rib can be a cause of distress is when it is completely misaligned from your upper body. The result is the arm, neck, shoulder, and back pain. This happens because all body systems are connected and interdependent, and therefore, in the event any piece gets out of place, it puts a strain on other surrounding structures.

What are the causes of Elevated First Rib?

CauseFirstRibMovementYour scalene muscles are normally incredibly strong, offering a lot of support to your head when it is on top of your spine. The human head has unstable weight, and therefore, there is a need for sufficient strength to be able to hold it in place effectively. This power means that they can lift the first rib up in case they are inflexible or shortened. They are involved in most cases of the elevated first ribs.

So, what causes the rib to rise? Well, in the modern world, sitting takes up most of our time and activities creating an imbalance in your form and posture. A closely related condition is the forward head posture. When these behaviors are consistent and repeated over time, the fascia membrane that normally surrounds the muscle, the scalene muscles become more and thicker, shorter and less flexible.

The overall effect is a reduction in the length of the scalene muscle group forcing the first rib to push up, crushing, and pinching the nerves and blood vessels that are located in that area. However, it’s also possible for an individual to have a raised first rib, and this happens due to injury, and especially to individuals who are known to hold their shoulders up habitually. Emotional tension is a risk too.

What treatment options are available?

In case you have an elevated rib that might be stuck in position; it’s vital that you have it removed immediately. Unless it’s a minor problem, you might need to consult a professional chiropractor to make adjustments on the offending rib back to position. Once you have it is adjusted in place, you’ll want it to remain there.

Unless you address the cause of the elevated rib, any fixes that you carry out will be temporary. Therefore, you will need to carefully reflect on the way you sit at work, in school, or at home. It is highly likely that your overall posture will need to be adjusted so that there is a balance in the key muscles.

Your First Rib is Affected by Body Movement

It is very important to consider your body usage. Over time, and in the course of daily routines, we develop poor postural structures, especially how we sit, work or balance our posture. When repeated over time, the fascia located in and around the scalene muscles will begin to become shorter, denser and thicker. Some common postures that will affect your scalene muscles include:

  • Leaning on your elbow while sinking into a posture
  • Having a forward head position caused by chronic slouching
  • Carrying something with a shoulder strap on the same site over a long period
  • Holding your phone between your shoulder and ear
  • First Rib and Trauma

The following are injuries and trauma that can affect the scalene muscles causing injury to the neck:

  • Birth Trauma that normally lasts up to adulthood
  • Impacts to one side of the neck or head
  • Incidents that cause whiplash

Another thing individuals who have bilateral Thoracic Outlet Syndrome. A condition where both arms and hands are normally affected is past emotional trauma. In a fight or flight situation, the affected individual might have experienced emotional trauma. Or fright in defense to protect themselves by holding their breath or raising their shoulders.

ElevatedFirstRibThoracicOutletSyndromeThis normally happens when the person fears for their life feeling the need to protect themselves. They suck in the air fast and deep raising their ribs, and due to stress and fear; they do not let their shoulders dropdown. Over time, the holding pattern gets cemented in place making it easier for Thoracic Outlet Syndrome to develop.

Symptoms of Elevated First Rib

The symptoms of elevated first rib normally range from the neck, jaw, and shoulder pain and may lead to difficulty breathing or arm numbness. The first rib is a generally unstable body structure that normally works as an attachment site for several other muscles, including the scalene.

At the upper cross forward, the scalene can become hypertonic, exerting an upward pull on the rib. In chronic situations, during fixed inhalation, the first rib can be jacked up painfully freezing in action, setting the stage for possible brachial plexus as well as thoracic outlet syndrome. Depending on your condition, patients will opt for the removal of the first rib.

Assessment of Elevated First Rib

More than 90% of the assessment of a fixed rib can be done by looking at the patient’s history. There is a palpation exam that is normally conducted just for confirmation purposes. It’s vital that your physician examines your lifestyle leading to episodic injuries. Most times, your physician will check for sleeping habits, hours spent on the computer, work demands and all other injuries from simple to those that are considered life-changing.

The most commonly affected are the stomach sleeping population or individuals who sleep with one arm tucked under their heads. Most of the time, victims will experience tightness in their upper shoulder girdle as well as a constant dull pain.

Also, whiplash injuries will contribute to the first rib involvement. Golfers, Tennis Players, and weight lifters will also get affected by neurovascular compression from first rib fixations.

How Can I Improve my Condition?


  • Getting a posture coach could go along way in improving your conditions. Other practices you could try to include the following:
  • If possible, make it a habit to regularly stretch the scalene muscles to help counter any tension or shortening.
  • Make a point to critically assess your sitting position and fight back in case you have a poor sitting habit.
  • If you constantly carry a bag or something that puts a strain on your back; find a balance in the way you do it, avoid carrying items on one side. Keep the weight close to your body as possible. If possible, switch sides or stick to carrying at the center.
  • Try to correct your general body posture the moment you notice it might be misaligned. It’s important to note that postural imbalances, particularly those that often lead to tension around your neck will lead to the development of an elevated first rib.
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