ming
the thenar eminence, and the finer movements of the thumb and fingers
are impaired.

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.

[Illustration: 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.

The _treatment_ consists in ensuring free action of the bowels and
kidneys, in inducing hyperaemia by means of heat, and applying gentle
massage. Salicylates and similar dr