Bauhaus-Universität Weimar

Titel:
The Cyclopaedia of Anatomy and Physiology, vol. 4: Pla [corr.: Ple] - Wri
Person:
Todd, Robert Bentley
PURL:
https://digitalesammlungen.uni-weimar.de/viewer/image/lit29465/588/
578 ABNORMAL CONDITIONS OF THE SHOULDER JOINT. 
simple chronic arthritis of the shoulder ; se¬ 
condly, we shall describe those which belong 
to chronic rheumatic arthritis of the same arti¬ 
culation. 
While the two chronic diseases of the 
hip, namely, the scrofulous affection and the 
chronic rheumatic arthritis of this joint, have 
of late years attracted much attention from 
the profession, it appears to the writer of this 
article that the corresponding diseases of the 
shoulder joint have been much overlooked. 
He hopes, therefore, he shall be excused if he 
deems it necessary to enter into more than 
ordinary details relative to the two chronic 
affections of the shoulder joint, which he will 
now endeavour faithfully to delineate. 
Simple chronic arthritis of the shoulder may 
be the result of a sprain or contusion : the 
synovial and fibro-synovial structures are in 
this case principally affected. If, however, 
the inflammatory action be not arrested, the 
bones, as well as their cartilaginous incrusta¬ 
tions, become ultimately engaged, and true 
articular caries is established. The disease 
sometimes begins in the shoulder joint, with¬ 
out the patient being able to assign any cause 
for it ; and in this case it may have a consti¬ 
tutional origin, and be the result of struma, 
or acute rheumatism, which last having sub¬ 
sided in the other joints, has concentrated 
itself on this one articulation, assuming the 
form of an articular caries. We have known 
it also appear in ,a young female during the 
convalescence from a long-continued gastric 
fever. 
Symptoms,—The first symptoms the patient 
suffers from, who is affected with simple 
chronic arthritis, or articular caries of the 
bones which enter into the formation of the 
shoulder joint, is a sensation of weight, weari¬ 
ness, and aching in the affected arm. These 
signs of the disease are at first not constantly 
present ; they appear and then disappear, to 
return again in some days. Some stiffness in 
moving the affected arm is next complained of, 
to which is soon added pain, which the patient 
says is deeply seated in the joint, and which is 
augmented by using the articulation, or when 
the articular surfaces are pressed against each 
other. These symptoms are seldom so severe 
as to prevent the patient from following his 
ordinary occupations. 
So far the disease may be said to be merely 
in its commencement ; but very soon we ob¬ 
serve it to pass into the second stage, when it 
may be discovered, on minute inquiry, that 
there is some sympathetic disturbance of the 
system — some heat of skin and slight acce¬ 
leration of the pulse. 
On examining the affected joint, we observe 
that the patient habitually carries it higher 
than the opposite shoulder, and the clavicle at 
the affected side is observed to pass, as it 
were, obliquely upwards and outwards, the 
adipose and cellular tissue, as well as all the 
muscles around the shoulder joint waste. 
The deltoid muscle, in a state of atrophy, 
appears stretched longitudinally, and the 
affected shoulder to have lost much of its 
normal roundness. The acromion process 
projects (see fig. 427.), and the arm of the 
affected side appears, and is usually found, 
on comparative measurement, to be really 
lengthened; the anterior fold of the axilla 
is deepened by the descent of the humerus 
from the glenoid cavity. The pain increases, 
and extends downwards from the shoulder 
to the inside of the elbow and wrist. 
In the third period of the disease, the wasted 
condition of the muscles around the shoulder 
joint, as well as those of the whole upper 
extremity, becomes still more obvious, and 
now the arm, which was really longer than 
natural, becomes gradually shorter. It is 
quite possible that, after the limb has become 
shortened, any pain or uneasiness felt in 
the joint may subside, and a process of true 
anchylosis be established before suppuration 
takes place ; but it much more frequently 
occurs, that about the time of the shortening 
of the limb, or subsequently, a chronic symp¬ 
tomatic abscess will make its appearance, and 
perhaps open spontaneously, in the axilla, or 
on some point along the outline of the deltoid, 
or inferior margin of the pectoral muscle ; 
and then the disease may be said to be in the 
fourth stage. 
This very serious chronic disease of the 
shoulder may be sometimes arrested in its 
early stage, and the patient recover the use of 
the joint; but, on the other hand, the disease 
frequently ends unfavourably by hectic fever, 
with its fatal consequences supervening. The 
more usual course for the disease to run will 
be found in general to be, that suppuration 
will tak e place, abscess after abscess will form, 
their purulent contents escaping and con¬ 
tinuing to flow, greatly exhausting the strength 
and spirits of the patient ; but under the in¬ 
fluence of good air and judicious management, 
the discharge from the abscesses may cease, 
the constitution improve, and true bony an¬ 
chylosis of the shoulder joint be established. 
The history of the two following cases of 
simple chronic arthritis of the shoulder, at 
this moment (June, 1848) under treatment at 
the Richmond Hospital, will serve to illus¬ 
trate some of the preceding observations as to 
the symptoms which patients usually labour 
under when affected by this chronic disease. 
Case 1. Chronic arthritis of the right shoulder 
joint of four years' duration. The disease in 
the second stage. — Margaret Moore, æt. 27, 
servant, admitted March 8th, 1848, under 
the writer’s care. She complained of stiff¬ 
ness and weakness of her right shoulder 
(fig. 427.), and of pain, which was much 
worse at night than during the day ; she 
had also a constant uneasiness at the inner 
side of the right elbow, and her nights 
were restless, her sleep interrupted by spas¬ 
modic starting of the whole limb, and pain 
extending down to the wrist and back of the 
hand ; she states that she has really more 
pain in the elbow and wrist than in her 
shoulder, and that these pains are increased 
when the arm is moved, or the articular sur¬ 
faces are pressed against each other. When-
        

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