Annual and analytical cyclopaedia of practical medicine . rect manipulationof the head may be of assistance. If Kochers method fail, tractiondownward and outward (never upward DISLOCATIONS. SHOULDER. TREATMENT. 13 and outward, on account of the dangerof lacerating the vessels) should be a long, steady pull, manual or elas-tic, the deltoid may yield and allow thehead of the bone to be pushed back intoplace. Or, after a few moments of trac-tion, the arm is violently adducted overthe closed fist in the axilla (this is saferthan the heel). If anaesthetics are usedall of these violent m
Annual and analytical cyclopaedia of practical medicine . rect manipulationof the head may be of assistance. If Kochers method fail, tractiondownward and outward (never upward DISLOCATIONS. SHOULDER. TREATMENT. 13 and outward, on account of the dangerof lacerating the vessels) should be a long, steady pull, manual or elas-tic, the deltoid may yield and allow thehead of the bone to be pushed back intoplace. Or, after a few moments of trac-tion, the arm is violently adducted overthe closed fist in the axilla (this is saferthan the heel). If anaesthetics are usedall of these violent measures should beexecuted verv cautiouslv. these methods fail, even under anaes-thesia, an open arthrotomy should bedone for the purpose of discovering andremoving the obstacle to reduction. In intracoracoid dislocations the headis displaced farther inward and the symp-toms are those of the subcoracoid, exceptthat the head of the humerus is feltfarther displaced and the shoulder ismore flattened. The arm may be fixedin horizontal abduction. The cause of. Fig. 6.—Subcoracoid dislocation on a cadaver, showing rupture of lower partof subscapularis. (B. Aiif/cr; Stimson, Dislocations.) Dr. Cole suggests a method which heclaims is successful in a large number ofcases. The surgeon, standing by thepatients side, holds the arm abductedand the elbow flexed, and, while distract-ing the patients attention, gently oscil-lates the arm. As the deltoid is seen torelax, a sharp blow is delivered into thefold of the elbow and the arm rotatedsharply outward, thus rolling the boneinto place. If judicious attempts at reduction by this particular dislocation is, as a rule,an unusual amount of laceration of thecapsule and subscapularis, which allowsthe head of the bone to slip higher intothe axilla. Reduction by outward trac-tion is easy unless the subscapularis ora torn portion of the capsule such cases operation is the only re-course. In subclavicular dislocations the sameforces act
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