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

  • William Williams Keen
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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    bare and retracted backward. There were no muscular attachments to the cervical rib. The cervical rib was now freed and cut olf at its base with a chisel. A portion of the remainder of the rib was cut away with rongeur forceps. The rib was 1^ inches long and f inch wide at its widest part (Fig. 26). Its anterior end was pointed and connected with the first dorsal rib by a slight ligamentous band. No injury to pleura. Catgut sutures in muscles. Silkworm-gut in skin. No drainage. After the operation she suffered very considerable pain above the clavicle, about the site of the operation, not under the arm and along its inner border, as heretofore. This pain continued for about six weeks without much change, when it gradually diminished. How- ever, as soon as the patient began to use the arm, such use caused pain in the scapular region, and if the exercise was continued the whole arm began to ache. There has been constant but very slow improvement. The patient was last seen on August 10, 1906, and while the pain and tenderness above the scapula had almost entirely disappeared and she had no pain in the arm when quiet, exertion of almost any kind, if continued for more than twenty or thirty minutes, caused first discomfort, and then a decided ache. As regards atrophy, strength, and function of the hand, it could not be said that there had been any improvement. On the whole, the results of operation were disappointing, although it is reasonable to suppose that improvement will continue for a long time. Case 38. Francis D. Patterson (personal communication). Woman, aged thirty-five, had suffered from children’s diseases; diphtheria at fifteen; quinsy at twenty-one; malaria at twenty-four; rheumatism at thirty-one; typhoid at thirty-four. At twenty-eight she was operated on for an ovarian abscess. July 19, 1905, at thirty-five years of age, she noticed a swelling on the right side of the neck, with pain in the distribution of the brachial plexus. A ceivical rib was diagnosticated. She was operated upon August 2, 1905, by a vertical incision along the posterior border of the sternocleidomastoid. The pleura was punctured and a late pneumothorax developed. Uninterrupted recovery took place, but a pressure paralysis followed, probably as a result of the forcible retraction of the brachial plexus. All the earlier symptoms, caused by the cervical rib, had steadily improved up to January 6, 1906. Dr. Rhein examined the patient October 26, 1905. There was complete paralysis of all the muscles below the elbow, except that there were feeble pronation and supination. Flexion and exten- sion of the fingers absolutely lost; deltoid unaffected, but pectoral muscles weak; latissimus dorsi, supraspinati and infraspinati intact; biceps and triceps, especially the latter, very weak. Marked ten- derness along the nerve trunks. Straightening of the fingers caused great pain. No loss of sensation either to pin-point, heat or cold.
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