Wasting of the hand associated with a cervical rib or band

Nine patients are described with unilateral wasting of the hand muscles associated with elongated C7 transverse processes or with rudimentary cervical ribs. In three patients there was selective wasting of the lateral part of the thenar pad, accompanied by mild weakness of the other hand muscles. In four patients all the hand muscles were wasted, but this was more marked in the lateral part of the thenar pad than elsewhere. In two patients wasting was uniformly distributed throughout the hand. Weakness and wasting in the forearm was only present in four patients and was relatively mild. Sensory loss, when present, affected mainly the inner side of the forearm. Nerve conduction studies revealed no abnormality in the distal part of the median nerve, but some patients had reduced or absent sensory action potentials when the fifth finger was stimulated. In all nine patients a sharp fibrous band was found at operation, which extended from an elongated C7 transverse process or from a rudimentary cervical rib to the region of the scalene tubercle on the first rib. The fibrous band caused angulation of the C8 and T1 roots in five patients, and of the lower trunk of the brachial plexus in three. Pathological changes were frequently visible in affected nerves at the site of angulation. Division of the fibrous band relieved pain and paraesthesiae in eight patients and arrested muscle wasting and weakness in nine patients. There was, however, only slight recovery of power in affected muscles; wasting in the hand appeared to be unchanged after periods of up to eight years.