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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    nuirimir heard best at the apex. The lungs are apparently normal. There is no pulse whatever in the axillary, brachial, radial, or ulnar arteries on the left side. The left subclavian can be felt above the left clavicle running downward and cutward to the clavicle for a distance of 6 cm. (Fig. 1). Its width as ascertained by putting one finger upon each side of the vessel, and including, of course, two layers of skin and subcutaneous tissue, is 18 mm. It pulsates very strongly to the touch. Though there is no thrill, a stethoscope, applied over the artery reveals a local bruit which is not propagated. Behind the artery is a rounded swelling above the left clavicle a little internal to the junction of its middle and outer thirds. On deep palpation this swelling is found to be part of a hard bony mass which can be traced backward to the spinal column. As it curves forward it seems to pass behind the clavicle. The artery passes in front of (that is, over) this bony prominence, which was diag- nosticated as a cervical rib. The left hand is distinctly cold and very much paler than the right. The nail of the middle finger is entirely loose and there is an ulcerated surface corresponding to the site of the nail, passing through the tip of the finger midway between the dorsal and the plantar surfaces. The other four nails are discolored and the tips of the fingers are somewhat ulcerated, the worst being the ring finger. This ulceration is the result of the sloughing off of the slight gangrenous patch from the subungual space (Fig. 1). A slight bruit can be heard over the right subclavian, but it is much less distinct than that over the left. There is no thrill on either side. Behind the right subclavian arteiy also a cervical rib is present and can be traced back to the spine. Both of the cervical ribs are immobile. A skiagraph (Fig 2) shows bilateral cervical ribs, the left being the larger rib. The right subclavian arteiy also runs much higher than is usual and can be traced upward from about the junction of .the middle and outer thirds of the right clavicle for a distance of 3.5 cm. Its width, measured as already estimated on the opposite side, is 15 mm. These measurements for the diameter of the vessels naturally should not be taken too exactly. The pulse on the right side is normal. The muscles of the left shoulder and the entire arm are considerably wasted. This is due in some measure to non-use of the hand, for all of the joints of the fingers, from having been kept of late quiescent and part of the time poulticed, have become par- tially ankylosed. The right arm at the middle of the biceps measures 24.5 cm.; the left arm, 24 cm.; the right forearm, S cm. below the external condyle 20 cm.; and the left forearm, 8 cm. below the external condyle 18 cm.