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/lit29465/622/
612 ABNORMAL CONDITIONS OF THE SHOULDER JOINT. 
imperfect and irregular union. The muscles of 
the dorsum scapulae were diminished, by being 
thrown out of use, and the tendon of the long 
head of the biceps muscle was entire, but 
glued down by adhesion.” Upon further ex¬ 
amination of the scapula and os humeri, Sir 
A. Cooper found the muscles and the situation 
of the bones to be as follows: — “ The head 
of the os humeri was placed behind the glenoid 
cavity of the scapula, and rested upon the 
posterior edge of that articular surface, and 
upon the inferior costa of the scapula, where 
it joins the articulation. When the scapula 
was viewed anteriorly, the head of the os hu¬ 
meri was placed in a line behind the acromion 
but below it, and a wide space intervened be¬ 
tween the dislocated head of the bone and the 
coracoid process, in which the fingers sunk 
deeply towards the glenoid cavity of the sca¬ 
pula. When viewed posteriorly, the head of 
the os humeri was found to occupy the space 
between the inferior costa and spine of the 
scapula, which is usually covered by the infra¬ 
spinatus and teres minor muscles. The tendon 
of the subscapularis muscle, and the internal 
portion of the capsular ligament, had been 
torn at the insertion of that muscle; but the 
greater part of the posterior portion of the 
capsular ligament remained, and had been 
thrust back with the head of the bone, the 
back part of which it enveloped. The supra- 
spinatus muscle was put upon the stretch, the 
subscapularis was diminished by want of ac¬ 
tion, and the infra-spinatus, and teres minor 
muscles were shortened and relaxed, as the 
head of the bone carried their insertions back¬ 
wards. The tendon of the long head of the 
biceps muscle was carried back with the head 
of the bone, and elongated; but it was not 
torn. As to the changes in the bones, the 
head of the os humeri, and the outer edge of 
the glenoid cavity of the scapula, were in di¬ 
rect contact, the one bone rubbing upon the 
other when the head of the os humeri was 
moved ; and this accounted for the sensation 
of crepitus at the early period of the disloca¬ 
tion, as there was no fracture. The glenoid 
cavity was slightly absorbed at its posterior 
edge, so as to Torrn a cup, in which the head of 
the bone was received, and this latter bone and 
the articular cartilage had been in some degree 
absorbed where it was in direct contact with the 
scapula, as well as changed by attrition during 
the seven years the patient lived.” The surface 
of the original glenoid cavity, instead of being 
smooth and cartilaginous, was rough and irre¬ 
gular, having elevations at some parts, and 
depressions at others. The extremity of the 
acromion was sawn off, to look for any little 
fragment of bone which might have been broken 
off, but not the smallest fracture could be per¬ 
ceived. 
Mr. Key, in his account of another case of 
dislocation of the os humeri backward on the 
dorsum of the scapula, writes as follows : — 
“ I found a very stout man sitting up in bed 
in great pain, and complaining more than 
patients commonly do under dislocation, and 
I concluded it to be some fracture about the 
cervix, especially as at first view nothing could 
be seen of a hollow under the deltoid muscle, 
the joint appearing round as usual. On pass¬ 
ing to the man’s side to examine the limb, the 
deformity of the shoulder became visible, the 
forepart appeared flattened, and the back of 
the joint fuller than natural : the head of the 
bone could be seen as well as felt, resting on 
the posterior part of the cervix scapulae. The 
elbow could be brought to the side, or raised 
on a level, with the acromion. Rotation out¬ 
wards was entirely impeded, in consequence of 
the subscapularis being stretched, all motions 
of the limb giving him extreme pain, which 
was referred to the lower part of the deltoid 
muscle, in the direction of the articular nerves, 
which were probably injured by the pressure 
of the head of the bone.” 
The dislocation of the head of the hu¬ 
merus backwards on the dorsum of the 
scapula is said to be very easily recognised, 
yet the writer has seen two examples of it 
which had been overlooked at the moment of 
the accident, and he has heard of two others. 
When the swelling, the result of the lacera¬ 
tion of parts, has subsided, the nature of the 
injury becomes very evident indeed. A gentle¬ 
man, Mr. A. F., aged about 35 years, called 
upon the writer four years ago to examine his 
shoulder. He stated that he was thrown off a 
jaunting car about three months previously, 
and injured his shoulder, and that ever since 
he had had but very imperfect use of his arm. 
The patient had been educated as a medical 
man, had practised surgery, but did not him¬ 
self suspect the nature of the injury, when, 
Fig. 440. 
Case of Mr. A. F.— Dislocation of the head of the 
humerus backwards on the dorsum of the scapula. 
about ten weeks after the accident, he called 
upon the writer. The nature of the injury
        

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