When pressure symptoms are present, the extra rib should be removed through an incision which exposes the posterior triangle sufficiently to admit of the bone and its periosteum being excised, without damage being inflicted on the brachial plexus, the subclavian artery, or the pleura.
Similar clinical features to those of cervical rib may be caused by a prominent transverse process of the first thoracic vertebra and similarly got rid of by its removal.
Branchial cysts and branchial tumours are described with tumours of the neck ([p. 598]).
Wry-Neck or Torticollis.—The term wry-neck or torticollis is applied to a condition in which the head assumes an abnormal attitude, which is usually one of combined lateral flexion and rotation.
The most important form is due to faulty action of the cervical muscles, and three varieties of muscular wry-neck are recognised—(1) the acute or transient; (2) the chronic or permanent; and (3) the spasmodic.
Acute or transient wry-neck—so-called “rheumatic torticollis”—comes on suddenly, usually after the patient has been exposed to a draught of cold air or to damp. The condition is popularly known as “stiff neck,” and is probably associated with fibrositis of the affected muscles. The sterno-mastoid, and often the trapezius, are contracted, and pull the head to one side, twisting the face slightly towards the opposite side ([Fig. 270]). There is tenderness on pressing over the affected muscles, and sometimes over the vertebral spines, and in the lines of the cervical nerves, and severe pain on attempting to move the head. Usually in the course of a few days the condition passes off as suddenly as it came on, but in some cases a certain amount of wasting of the affected muscles ensues.
Fig. 270.—Transient Wry-neck, which came on suddenly after sitting in a draught, and passed off completely in a few days.
In the diagnosis of this form of wry-neck it is necessary to exclude such conditions as cellulitis, inflammation of the cervical glands, and disease of the cervical spine, in which the head may assume an abnormal attitude, the position being that which gives the patient greatest comfort.