The gilliatt-sumner hand

Abstract

One form of NTOS results in the development of a clinical finding known as the Gilliatt-Sumner hand (GSH). The clinical features of GSH include weakness and atrophy of the thenar, hypothenar, and interossei intrinsic hand muscles. In addition, there is hypesthesia in the ulnar and medial antebrachial cutaneous distribution, but normal median nerve sensation. Electrical findings include decreased median and ulnar compound muscle action potentials (CMAP's) and ulnar and medial antebrachial cutaneous (MAC) sensory nerve action potentials (SNAP's). GSH has a frequent association with congenital anatomic variations which cause entrapment of the lower trunk of the brachial plexus. These variations include bony anomalies such as hypertrophic C7 transverse processes and cervical ribs, or soft tissue abnormalities like a cervical band, Sibson's fascia, or thickened medial border of the scalene muscle. In this subgroup of NTOS patients, a surgical decompression is indicated. Surgical results indicate that symptom progression is usually stopped, and often the pre-existing neurological de fi cits are reversed.