The practice of surgery . tent as almost to admit of the hand being placedbetween the subscapularis and the ribs. In this case, treatment mustbe mainly constitutional; but the attention is also directed towardsrestoration of tone in the faulty muscles, by galvanism, friction, andother means. Dislocation of the Humerus at the Shoulder. This is more likely to follow indirect than direct violence, as formerlyexplained (Principles, 3d Am. Ed. p. 675). There are varieties ; threecomplete luxations, and two partial displacements. 1. Dislocation downwards, into the axilla, is the most common—indeed,
The practice of surgery . tent as almost to admit of the hand being placedbetween the subscapularis and the ribs. In this case, treatment mustbe mainly constitutional; but the attention is also directed towardsrestoration of tone in the faulty muscles, by galvanism, friction, andother means. Dislocation of the Humerus at the Shoulder. This is more likely to follow indirect than direct violence, as formerlyexplained (Principles, 3d Am. Ed. p. 675). There are varieties ; threecomplete luxations, and two partial displacements. 1. Dislocation downwards, into the axilla, is the most common—indeed, is regarded as the ordinary form of injury. In addition to thegeneral signs of dislocation, there are the following: The shoulder isflattened, the deltoid having sunk inwards; an ample and evident spaceexists beneath the acromion, which process is unusually and strikinglyprominent; the arm is slightly elongated, the elbow is abducted fromthe side ; on elevating the limb, the head of the bone is plainly felt in Fig. Dislocation of the Shoulder. The flattening shown at a. The right shoulder is normal. the axilla—and it is found to move with the shaft in rotation ; motionis greatly abridged, unless when the muscular system is unusually relaxedand flabby; there is no true crepitus; pressure of the bones head onnerves and veins in the axilla is evinced, by tingling sensations andswelling of the limb ; paralysis may follow; not unfrequently the cir-cumflex nerve has been torn across, and permanent paralysis of thedeltoid has resulted. Reduction may be effected, in a variety of ways ; pulleys being usedor not, according to circumstances (Principles, 3d Am. Ed. p. 080, &c). 326 DISLOCATION OF THE SHOULDER. In all cases of difficulty, chloroform is of course employed (Principles,3d Am. Ed. p. 735). a. By rectangular extension—the axis of exten-sion being intended to relax the deltoid, supra-spinatus, and infraspi-natus muscles, which, according to Sir A. Cooper, are the prin
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