An elevated first rib is an underappreciated cause of neck and shoulder pain as well as numbness and tingling down the arm. Common causes of an elevated first rib can be trauma such as whiplash where the head and neck get side bent, sleeping on the stomach and/or with the arm overhead, or repetitive usage of the arm overhead. Poor posture can contribute to an elevated first rib because it puts a strain on the scalene muscles which in turn can “pull” the first rib up.
When the first rib is elevated the Brachial Plexus (the nerve bundle that sends sensation to the arm and hand) as well as the arteries and veins that go between the collarbone and first rib can become compressed causing symptoms down the arm.
An elevated first rib usually can be corrected with muscle energy technique or manipulation by your Physical Therapist. Additionally, dry needling of the SCM and scalene can help relieve associated myofascial pain. If you are experiencing pain in your neck or shoulder with associated tingling Physical Therapy may be a good solution.