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/lit29465/625/
ABNORMAL CONDITIONS OF THE SHOULDER JOINT. 615 
In one case detailed by Sir A. Cooper, the 
tubercles were broken off with the head of 
the bone, and the fractured extremity of the 
neck of the os humeri was placed in the 
glenoid cavity of the scapula. In another 
case, the fi’acture was intra-capsular, and the 
head of the bone was at the same time dis¬ 
located forwards, under the pectoral muscle, 
and placed at the inner side of the coracoid 
process. 
Delpech* gives the history of a case of 
fracture of the anatomical neck of the hu¬ 
merus, combined with a dislocation. The 
case was remarkable, and differed from all 
the others recorded, in being an example of 
that rare form of dislocation, where the bone 
is thrown on the dorsum of the scapula. The 
history of the case is accompanied with an 
engraving. 
With regard to the case of dislocation into 
the axilla, complicated with fracture, Sir A. 
Cooper says, “ 1 would observe that in this 
case the fall and depression of the shoulder 
is less striking than in the case of simple ax¬ 
illary dislocation, as the shaft of the bone 
fills up the glenoid cavity ; also, that in the 
case complicated with fracture, the head of 
the bone can still be distinctly felt in the axilla, 
and that as it does not move when the os 
humeri is rotated from the elbow, this be¬ 
comes the principal diagnostic mark. 
“ That a grating sensation can generally be 
felt, and sometimes a very distinct crepitus, 
especially if the elbow be raised outwards 
during the rotation of the arm. 
“ That the upper extremity of the shaft of 
the humerus can be felt advancing to the 
coracoid process ; but that it is easily re¬ 
turned into the glenoid cavity, and that it 
there rotates with the arm, but easily again 
slips forward. 
“ That the accident which produces it is 
much more severe than that by which simple 
dislocation into the axilla is produced ; and 
there is, therefore, more contusion, more 
swelling, and more pain.” 
Muscles.—If in some cases the tuberosities 
of the humerus are broken off and remain 
connected with the muscles when the head 
of the humerus is dislocated, in others, we 
may be prepared to expect that in the dis¬ 
section of cases of dislocation, the capsular 
and other muscles will be found lacerated. Tf, 
as has been stated, the supra-spinatus be the 
muscle which is most put on the stretch when 
the head of the humerus is dislocated down¬ 
wards, we need not be surprised to learn that 
this muscle is very frequently found to have 
been ruptured, or to have torn away a frag¬ 
ment of bone from the head of the humerus. 
In the dislocation on the dorsum of the 
scapula, the dissection of which is detailed in 
Sir A. Cooper’s work, we find the following 
observations made by Mr. Key, with reference 
to a very peculiar phenomenon noticed in 
that case : namely, “ that, during the patient’s 
life-time it was thought probable that a portion 
* Clinique Chirurgicale, Paris, tom. i. p._234. 
of the glenoid cavity had been broken off, or 
a piece of the head of the os humeri, or 
perhaps the smaller tubercle ; and that any 
of these injuries would account for the head 
of the bone not remaining in its natural 
cavity when reduced ; but the inspection post¬ 
mortem proved that the cause of this symptom 
was the laceration of the tendon of the sub- 
scapularis muscle, which was found to adhere 
to the edge of the glenoid cavity, and much 
thickened and altered in its character from its 
laceration, and very imperfect and irregular 
union.” 
The tendon of the long head of the biceps 
is sometimes altered, as to its direction, in 
cases of complete dislocation, and adhesions 
between it and the contiguous parts occur ; 
but there are very few cases recorded, or to 
be found in museums, which prove that in 
true dislocation from accident, the tendon 
was found ruptured. In this respect, the 
effects of accident and disease on this tendon 
are strongly contrasted ; for, as the result of 
disease, the tendon, so far as its articular por¬ 
tion is concerned, is very generally removed 
altogether. 
Besides lesions affecting the bones, mus¬ 
cles, and tendons, injuries of other tissues 
may be found occasionally to accompany or 
succeed to dislocations of the shoulder. 
A dislocation of the head of the humerus 
may be accompanied with an œdematous 
swelling of the arm and forearm ; with a pa¬ 
ralysis of the dislocated extremity, or with a 
laceration of the axillary artery, and a dif¬ 
fused aneurism ; it is said also that occasion¬ 
ally an emphysematous swelling of the shoul¬ 
der has followed the reduction of the dis¬ 
location ; and on other occasions, that the 
articular structures have been attacked with 
very severe inflammation. For example, as 
to this last : Mr. Hunter gives an account of 
a case of dislocation of the shoulder-joint, 
which he dissected three weeks after its re¬ 
duction, from which, if we could be influenced 
by one case, we might infer that inflammation, 
though latent, may sometimes be the conse¬ 
quence of a dislocation of the head of the 
humerus. Mr. Hunter’s observation is as 
follows: “What was very remarkable, and 
what I did not expect, there was a good deal 
of püs in the joint." * 
Partial or general paralysis of the muscles 
of the arm has also been observed as a con¬ 
sequence of a dislocation of the head of the 
humerus, particularly when either the circum¬ 
flex nerve alone, which is that most usually 
injured, or all the nerves of the brachial 
plexus have been violently contused, or greatly 
stretched ; or even torn 'across either at the 
time of the accident, or by the violence of the 
means used to restore the luxated humerus, 
when the dislocation has been left long un¬ 
reduced. Flaubert, of Rouen, speaks of an 
emphysema of the chest succeeding his efforts 
to reduce an old luxation of the humerus ; 
* Pathological Catalogue of Museum of R. C. 
Surgeons, England, vol, ii. p. 20. No. 868. 
R R 1
        

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