Symptomatology, diagnosis, and surgical treatment of cervical ribs / by W.W. Keen.

  • Keen, William W. (William Williams), 1837-1932.
Date:
1907
Catalogue details

Licence: In copyright

Credit: Symptomatology, diagnosis, and surgical treatment of cervical ribs / by W.W. Keen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    For ten years she had complained of inconstant dull aching pain in the ball of the right thumb; worse in evening and after muscular exertion. Three or four years ago numbness in tips of right thumb and forefinger was observed. . One year ago atrophy of the ball of the right thumb was noticed, and at the same time she began to have aching pain in the internal aspect of the right forearm and over the deltoid. She had occasional pain above the right clavicle. A year ago the numbness extended to the tip of the middle finger. On admission the only muscle affected was the right abductor pollicis; the thumb movements were scarcely interfered with except- ing in abduction. For the sensory area, see diagram (Fig. 27). A skiagraph revealed bilateral cervical ribs, but they could not be definitely felt. The subclavian arteries were raised well above their usual levels. a b Fig. 27.—Case of Sargent and Buzzard (No. 42). a, diminished sense of pain; 6, diminished tactile sense. The darkest areas represent diminution of both. Operation, July 17, 1906, by Mr. Sargent. Triangular flap of skin corresponding to posterior cervical triangle; exposure of plexus; complete rib found, articulating with the seventh cervical and attached to the first rib. An angular prominence existed in the middle. “There was no indication that any part of the plexus was pressed or dragged upon in any way.” After operation the whole upper extremity was extremely weak. Sensation was unaffected. September 15, 1906: the arm is recover- ing, but there is still some wasting of the spinati, deltoid, biceps, and triceps. Sensation is the same as before operation. No definite electrical changes exist in any muscle. October 23, 1906: recovery of muscles of the fifth cervical segment is very slow.