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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    Case 37. Hugh T. Patrick, and S. C. Plummer (personal com- munication). Woman, aged twenty-four, bookkeeper and stenog- rapher, first seen January 25, 1905. Pain had begun in the right axilla eight years before and had gradually extended down the inner border of the arm, gradually becoming worse. Any over- exertion, such as prolonged writing or piano playing, increased the pain, and she positively affirmed that any undue excitement had the same effect. About four years before being seen, she first noticed disability in the fingers, in trying to pick up a pin. Three years before, loss of power in the thumb had reached such a degree that she could not hold a pencil in the ordinary way, and was forced to hold it between the index and middle fingers. By January, 1905, there was not only weakness in the small hand muscles, but the whole right arm was weaker. The pain seemed to start in the axilla and run down to the elbow and middle of the forearm, along the inner border. She had no pain in the hand or fingers, but occa- sionally pain seemed to extend from the axilla around to the scapular region. She did not know when the wasting had begun, but when she first noticed it two years before examination it had already become (juite marked. Fig. 26.—Specimen’removed in Patrick's Case 37. (Natural size.) In the histor}' of this case it is rather interesting to note that a diagnosis of writer’s cramp had been made by a prominent neurolo- gist, because of the difficulty in writing and the distress caused by it. Measurement showed the right hand, forearm, and arm each V inch smaller than the left. No distinct anesthesia could be made out. The skiagraph showed not only a cervical rib on the right, the affected side, but also one on the left almost as large. As the left rib has caused no symptoms, of course it has been let alone. Operation, March 16, 1905, by Dr. S. C. Plummer. Incision, three inches long, from clavicle at posterior border of sternocleido- mastoid muscle, obliquely upward and backward. Skin and platysma divided, also a part of trapezius and of sternocleido- mastoid, as these two muscles came close together, and the portions cut were quite thin. Brachial plexus exposed. It was not necessary to expose the subclavian artery. The posterior belly of the omo- hyoid muscle was exposed, and drawn forward and downward, along with the plexus and artery. The scalenus medius was laid