. Manual of operative surgery. id cavity. If it is filled with fibrous tissue, clear suchaway by dissection. If the capsule is in fair condition, preserve it; if it hindersreduction, divide it, and after reduction repair it by sutures. If the capsuleis in bad condition, , contracted and distorted, dissect it away. 6. Try to reduce the dislocation. This is usually possible. If, however,reduction is still impossible examine with the finger for the obstruction. Theobstruction is commonly muscular (supra and infraspinatus). Very graduallyseparate these muscles at their insertion into the great
. Manual of operative surgery. id cavity. If it is filled with fibrous tissue, clear suchaway by dissection. If the capsule is in fair condition, preserve it; if it hindersreduction, divide it, and after reduction repair it by sutures. If the capsuleis in bad condition, , contracted and distorted, dissect it away. 6. Try to reduce the dislocation. This is usually possible. If, however,reduction is still impossible examine with the finger for the obstruction. Theobstruction is commonly muscular (supra and infraspinatus). Very graduallyseparate these muscles at their insertion into the great tuberosity. Do not I094 SHOULDER separate them one iota more than is necessary for reduction. Separation of thesubscapularis from the lesser tuberosity is to be avoided if possible. Completethe reduction. 7. If sufficient capsule remains, repair it by sutures. With sutures restorethe soft parts, both deep and superficial, as nearly as possible to their normalcondition. Close the wound with or without drainage. Dress. Keep the. Fig. 1350.—(McBiiniey.) arm bound to the side until healing is complete. Begin passive motion early,using an anesthetic if necessary. The operation is more complex when there is fracture of the neck of thebone as well as dislocation of the head. If the head of the bone is seeminglysufficiently nourished reduction must be attempted by pushing and prying thehead of the bone with elevators, forceps, and McBurneys ingenious hook(Figs. 1350 and 13 51). Free division of resisting bands is of course necessary.
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