Bauhaus-Universität Weimar

The Cyclopaedia of Anatomy and Physiology, vol. 4: Pla [corr.: Ple] - Wri
Todd, Robert Bentley
affected with chronic rheumatic arthritis was, 
that the long intra-articular portion of the 
tendon of the biceps was absent from the joint, 
although adherent outside to the highest point 
of the bicipital groove (^g.428.). Thisremoval 
of a large portion of the tendon of the biceps 
strikes the observer who is unacquainted with 
this disease as a direct proof that the tendon 
had been ruptured by accidental violence, and 
that a partial luxation of the head of the hu¬ 
merus has been the consequence. 
Another character of this disease is, that 
the humerus has a very general tendency to 
pass upwards towards the coraco-acromial 
vault ; and besides the removal of the tendon 
of the biceps, the superior part of the capsular 
ligament is observed to be deficient. Those 
who do not know that this perforation is a 
consequence of slow disease, immediately take 
it for granted that the same accident which 
ruptured the tendon of the biceps had also 
caused the head of the humerus to be partially 
dislocated upwards, perforating as it passed 
the superior part of the capsular ligament. 
If, in addition to these abnormal appear¬ 
ances, small portions of bone, as if fragments 
broken off from the margins of the glenoid 
cavity, are found to be present, as they fre¬ 
quently are, this also is an appearance cal¬ 
culated to confirm an erroneous impression, 
that some external violence has been the 
source of it ; and if in addition the acromion 
process be found divided into two portions, 
as we have frequently noticed it, the preju¬ 
dice in the observer’s mind may at first be 
strongly in favour of the idea,'that accidental 
violence has been the source of these many 
and combined phenomena. 
But notwithstanding all these lesions, 
namely, the total disappearance of the articular 
part of the tendon of the biceps ; the perfora¬ 
tion of the superior part of the capsular liga¬ 
ment by the head of the humerus, and the 
separation into two portions of the acromion 
process, we feel convinced that all these phe¬ 
nomena combined should by no means be 
considered as proof of any accident having 
occurred to produce them ; but, on the con¬ 
trary, should be looked upon as the usual 
result of chronic rheumatic arthritis of the 
The tendon of the biceps in all those cases 
of presumed accidents is said to be ruptured; 
yet the chronic disease of the shoulder joint is 
frequently found to affect both shoulder joints 
in the same individual, and the long tendon of 
the biceps, in these cases, to be removed on 
both sides. It is easy to conceive that this 
double lesion may be the effect of disease, but 
difficult to imagine how any accidents could 
occur to “rupture” the tendons of the biceps 
in both shoulder joints. Nor is it easy to ad¬ 
mit that the long tendon of the biceps can 
be readily ruptured in partial dislocations of 
the humerus from accident, when we know 
that this tendon is rarely if ever ruptured, 
even in complete luxation of this bone. The 
statement made in the report of various cases 
in surgical works, and in the catalogues of 
museums, in which we find it briefly noted, 
“ that the tendon of the biceps was found 
ruptured,” has been made by the writers con¬ 
fessedly without any knowledge of the pre¬ 
vious history of the case, the anatomical cha¬ 
racters of which they are describing. On this 
account we feel the less delicacy, after long 
and patient consideration of the subject, in 
expressing our conviction that the tendon of 
the biceps, in the numerous cases published, 
was not (as supposed to be) ruptured by acci¬ 
dent, but absorbed as the result of disease. 
We have stated that the bones entering 
into the formation of the shoulder joints are 
very generally enlarged as a consequence of 
this chronic disease having for a considerable 
time existed in the articulation. It is right, 
however, here to observe, that very exten¬ 
sive inquiry into the pathological anatomy of 
this peculiar affection as it presents itself in 
the shoulder joint, will prove that some few 
exceptions to this rule may be occasionally 
met with ; and that, instead of the bones enter¬ 
ing into the formation of the shoulder joint 
being found hypertrophied, they may be dis¬ 
covered, on the contrary, to be in a state of 
atrophy ; or portions of these bones may be 
removed altogether, as the apparent result of 
this chronic rheumatic disease. 
That the writer may not appear to have 
been singular in having observéd the changes 
which the acromion process and neighbour¬ 
ing bones have undergone as the result of 
this chronic rheumatic disease, he may refer 
to the dissection of a case mentioned by 
Cruveilhier, in which the affection we have 
called chronic rheumatic arthritis was so ge¬ 
neral that there was scarcely any articulation 
in the body exempted from its effects. When 
adverting to the anatomical changes observ¬ 
able in the region of the shoulder in this ex¬ 
ample, he says, the external extremity of the 
clavicle and the neighbouring part of the 
acromion were in a great part destroyed, &c.* 
In the museum of the College of Surgeons 
in Dublin will be found a preparation of a 
shoulder joint, which is styled by the late 
Dr. Houston in his catalogue, a specimen of 
chronic rheumatic arthritis of the shoulder ; 
and that it was justly so styled may also be 
inferred from the “ bunches of synovial fim¬ 
briae,” which hung into the synovial cavity 
of the joint ; the existence of hydrops ar- 
ticuli, or over-distension of the synovial sac 
by an albuminous fluid ; and from the de¬ 
ficiency of the intra-articular portion of the 
tendon of the biceps, mentioned in the ac¬ 
count given of this case : — all these show the 
disease to have been correctly designated. 
The writer finds upon examining this prepa¬ 
ration with the intelligent curator, Mr. Carte, 
that the acromial end of the clavicle is un¬ 
supported, and that the acromion process has 
been removed for the amount of an inch in 
extent; that which remains for this process 
* Cruveilhier, livraison ix. p. 12.


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