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/lit29465/591/
581 
ABNORMAL CONDITIONS OF THE SHOULDER JOINT. 
of his patients, who died of articular caries of 
the shoulder joint, he discovered, when a 
vertical section was made of the humerus, 
that in the centre of the head of this bone 
there was contained a cavity or cell, the size 
of a hazel nut, filled with tubercular matter, 
in the middle of which were found fragments 
of necrosed particles of bone. In this case 
also, he adds, tubercular matter was found in 
the axillary glands.”* Bony nodules and 
stalactiform osseous productions are observed 
to be produced from different parts of the 
scapula and head of the humerus, in the vici¬ 
nity of the shoulder joint. The coracoid 
process and acromial end of the clavicle we 
have found in these cases carious ; the alter¬ 
ations of the osseous structure do- not seem 
confined to the bones in the immediate vici¬ 
nity of the joint itself. The whole scapula 
and humerus seem specifically lighter than 
they should be normally. We have tried the 
experiment of placing the diseased bones in 
water, and have seen them float, while the 
normal bones of the same region sink. The 
ribs, too, have been found sometimes carious 
simultaneously with the bones which con¬ 
stitute the scapulo-humeral joint. 
These observations refer merely to the local 
condition of the articular structures them¬ 
selves. The state of the constitution of many 
of these cases affected with chronic arthritis 
of the shoulder deserves the attentive con¬ 
sideration of the physician and surgeon. 
The prognosis to be formed as to any ad¬ 
vanced case of articular caries of the shoulder 
joint should be a guarded one, as the follow¬ 
ing facts may convince us. In the first case 
which we shall now adduce, fatal disease of 
the lungs seemed coincident with the articu¬ 
lar caries of the shoulder ; and at last it was 
doubtful which of the two diseases was the im¬ 
mediate cause of the death of the patient. In 
the second case disease of the brain, with 
paralysis, came on, and was the immediate 
cause of the death of the individual, who had 
been previously much reduced by articular 
caries of the shoulder. 
Case 3. Chronic arthritis or articular caries 
of the shoulder joint, lasting thirteen months. 
—Matthew M'Cabe, a labourer, set. 38, was 
admitted into the Richmond Hospital, Sept. 2. 
1846, under Dr. Hutton’s care.f He stated that 
about nine months previously he was seized 
with a pain in his left shoulder, which soon 
extended to his elbow ; he was able to work 
for two months after the first attack of pain, 
but after this period the arm became stiff^ 
and remained powerless by his side ; the 
muscles around the shoulder and of the 
whole extremity were wasted ; fistulous open¬ 
ings existed beneath the coracoid process, and 
through the deltoid muscle ; the limb was of 
its normal length. When the joint was pressed 
the patient complained of pain ; the motion 
of the head of the humerus on the glenoid ca¬ 
vity of the scapula appeared much limited ; 
* Traite des Maladies des Articulations, 
f The writer is indebted to Dr. Hutton for the 
notes of this case. 
he had cough and hectic fever, of which the 
prominent symptoms, beside the cough, were 
a quick pulse and diarrhoea. He died Jan. 25. 
1842. 
Post-mortem examination.— The body was 
emaciated. Before making the examination* 
a plaster of Paris cast was taken of the left 
shoulder joint, which is preserved in the hos¬ 
pital museum : this shows especially the wasted 
condition of all the muscles around the shoulder 
joint, and the consequent prominence of the 
spine and acromial process of the scapula, usual 
in cases of articular caries of the shoulder. For 
the space of two inches along the anterior 
wall of the axilla and line of the humerus an 
oblong depressed scrofulous ulcer existed, in 
which were seen the orifices of three or four 
fistulous canals, which led from the interior 
of the joint. The elbow was placed somewhat 
backward, and the long axis of the humerus 
was consequently directed from below up¬ 
wards and forwards ; the convexity of the 
head of the humerus, without being dislocated, 
was placed somewhat more forwards and in¬ 
wards than natural. Upon removing the 
deltoid muscle, which was wasted and per¬ 
forated by fistulous openings, it was found 
that the capsular ligament was contracted 
and thickened, and had several openings in it* 
and that purulent matter was effused both into 
the joint and under the deltoid muscle, which 
thus formed the sac of an abscess. The car¬ 
tilages had been entirely removed from the ar¬ 
ticular surfaces. The intra-capsular portion of 
the tendon of the biceps had disappeared ; the 
highest part of this tendon which remained was 
attached to the inside of the capsular ligament. 
The bones had been injected with size and 
vermilion, and presented in their interior as 
well as on their carious surfaces a reddish 
colour; but they did not appear softened; 
when after maceration they had been dried, 
they seemed to be preternaturally light. The. 
superior hemispherical portion of the head of 
the humerus had been removed very nearly to 
the level of the anatomical neck, or situation 
for the attachment of the capsules ; and the 
surface was red, porous, and much rough¬ 
ened from caries. Towards the highest part 
of the humerus, just within the line which 
separates the great tuberosity from the head 
of the humerus, there existed two very deep 
digital or alveolar depressions, which pene-. 
trated into the cellular structure of the head of 
the humerus : the anterior part of the upper- 
extremity of this bone, where the bicipital 
groove exists, was rough and porous ; the 
groove was much deepened, particularly in 
the situation of the lesser tuberosity, which 
was elevated into a bony nodule, and enlarged 
about one inch below the lesser tuberosity. 
On the front of the surgical neck there existed 
another bony nodule, but smaller. 
The surface of the glenoid cavity seemed to 
have been somewhat worn away and rendered 
more than naturally concave ; the anterior or 
inner margin of it was rounded off by caries, 
The oval outline of the glenoid cavity was elon¬ 
gated from above downwards, and somewhat
        

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