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/lit29465/595/
ABNORMAL CONDITIONS OF THE SHOULDER JOINT. 585 
be observed to be somewhat elevated, ad¬ 
vanced, and very generally approximated 
towards the middle line. When we view the 
articulation in profile (as it were), the amount 
of the advancement of the head of the hume- 
us is more readily appreciated. And when we 
look at the shoulder joint from behind, a very 
remarkable abnormal depression may be seen, 
which corresponds to the space or interval 
which exists between the posterior part of 
the glenoid cavity and the head of the hume¬ 
rus. . After a time, the voluntary motions of 
the joint become restricted within very nar¬ 
row limits. The patient cannot well abduct 
the elbow from his side, nor elevate it nearly 
to an horizontal level. The motions he is 
himself capable of communicating to his arm 
are chiefly confined to under movements, yet 
the head of the humerus is in some of these 
cases susceptible of an abnormal degree of 
mobility. Although in the ordinary form of 
this disease the head of the humerus will be 
found to be placed above its normal level, and 
is observed to be several lines higher than the 
coracoid process, still if the arm be grasped by 
the surgeon it can be drawn down, and the 
head of the bone will place itself beneath the 
coracoid process ; the joint will then as¬ 
sume all the appearances usually assigned as 
the marks of the case styled by Sir A. Cooper 
“ Partial luxation of the head of the humerus 
forwards and inwards.” In cases of long 
standing, the capsular ligament becomes wider 
than natural, and the articular surfaces are so 
altered that partial dislocation of the head of 
the humerus occurs in other directions besides 
those above alluded to ; but any observations 
we have to offer upon this part of our subject 
it will be more convenient to defer until we 
come to speak of the anatomical characters of 
this disease. 
Although the patient may complain of pain 
in the middle of the arm, and of spasms of 
the muscles, of the whole extremity of the 
affected side, even to the fingers, yet if the 
surgeon elevate the arm at the elbow, and 
press the humerus even rudely against the 
glenoid cavity of the affected articulation, the 
patient experiences no uneasiness. 
It is very remarkable that this peculiar 
affection of the shoulder joint has never, as 
far as we have known, terminated in anchy¬ 
losis, nor proceeded to suppuration ; nor has 
its presence excited any sympathetic disturb¬ 
ance in the constitution of the patient ; yet 
from year to year the disease slowly but gra¬ 
dually increases, until the patient is carried 
off by some other complaint, or dies from the 
mere effect of age alone. 
Diagnosis.—This peculiar affection of the 
shoulder joint, particularly when the history 
of the case is known, cannot well be con¬ 
founded with any other disease of the articu¬ 
lation with which we are acquainted. Scro¬ 
fulous caries of the bones of the shoulder 
joint may have some symptoms in common 
with the chronic disease we are describing, 
but there is more pain and more wasting of 
the muscles of the arm and fore-arm, and 
more sympathetic disturbance of the constitu¬ 
tion in the case of articular caries of the 
shoulder than in that of' chronic rheumatic 
arthritis of this articulation ; and while the 
former case usually proceeds to suppuration, 
or to anchylosis of the joint, these processes 
never take place in the latter. 
In the chronic rheumatic disease, the op¬ 
posite shoulder joint will, in general, be found 
symmetrically affected ; a circumstance we 
have never yet known to have been the case 
in a chronic arthritis, or articular caries, of 
the shoulder. 
The history of the case of chronic rheuma¬ 
tic arthritis usually betrays its nature by the 
general rheumatic pains the patient reports 
himself to have suffered from ; by the disease 
not being confined to the one articulation ; 
by the enlargement of the bony prominences 
about the joint, although the muscles are 
wasted. In both cases there may be crepi¬ 
tus felt on moving the joint and on making 
pressure ; but the efforts to elicit crepitus, 
and the pressing together of the articular sur¬ 
faces cause, in the case of chronic arthritis, 
or articular caries, so much pain, that the 
patient shrinks back from our attempts at 
making these trials ; while in the ordinary 
case of chronic rheumatic arthritis of the 
shoulder, when even it appears as a local 
disease confined to one or two articulations, 
we find we can even rudely press the head of 
the humerus against the surface of the glenoid 
cavity without causing the patient pain, just 
as we can, in the case of the same disease 
when it affects the hip joint, press the head of 
the femur against the acetabulum without 
causing the least uneasiness to the patient 
(see Vol. II. p. 799.). 
No doubt some few cases of chronic rheu¬ 
matic arthritis of the shoulder joint in the 
living and in the dead have been mistaken for 
partial dislocation of the head of the humerus, 
the result of accident ; but we are of opinion 
that, as the chronic rheumatic affection is 
daily becoming better known to the profes¬ 
sion than formerly, such errors will no longer 
be committed, particularly when the anato¬ 
mical characters of this disease have been more 
fully studied by the profession. 
Anatomical characters. — When we ana¬ 
tomically examine the shoulder joint of a 
patient who has long laboured under this 
chronic disease in the articulation, we notice 
on removing the integuments that the deltoid 
muscle is unusually pale, and that the inter¬ 
stices between its fibres are occupied by an 
unhealthy-looking fat. This and the sub¬ 
jacent capsular muscles are in a state of 
atrophy. The capsular ligament is generally 
altered in form and structure, and it will 
be sometimes found to have abnormal attach¬ 
ments above to the acromion or coracoid 
process ; and, below, its attachment to the 
anatomical neck of the humerus is some¬ 
times partially interrupted, allowing of an 
interval which in some forms of the disease 
permits the head of the humerus to pass 
through it.
        

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