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
