. Manual of operative surgery. expose the biceps tendon up to its origin above the glenoidcavity. Step 5.—Beginning at the posterior margin of the bicipital groove, separatethe periosteum, and with it the external rotators of the humerus from the greater 69 logo SHOULDER tuberosity, and retract these structures backwards. Inspect the biceps tendonand its sheath. Retract the tendon forwards. By flexing the elbow, rotatingthe shoulder, pushing the head through the wound, etc., etc., it is now possibleto inspect the whole joint and judge if it is necessary to resect the joint or if amere arthroto
. Manual of operative surgery. expose the biceps tendon up to its origin above the glenoidcavity. Step 5.—Beginning at the posterior margin of the bicipital groove, separatethe periosteum, and with it the external rotators of the humerus from the greater 69 logo SHOULDER tuberosity, and retract these structures backwards. Inspect the biceps tendonand its sheath. Retract the tendon forwards. By flexing the elbow, rotatingthe shoulder, pushing the head through the wound, etc., etc., it is now possibleto inspect the whole joint and judge if it is necessary to resect the joint or if amere arthrotomy will suffice. If arthrectomy is necessary proceed to—• Sup 6.—Subperiosteally separate the insertions of the muscle from the lessertuberosity forwards and inwards. Complete the resection, removing all diseasedtissue. Step 7.—Replace the deltoid flap and fix it in position by sutures. Providedrainage. Dress. Clavicular joint Acromial joint-— Tendon biceps-— Fragment scapula-— Deltoid Joint capsule ^-^incised. ,Supraspinatus Cut surface crest ofscapula Infraspinatus Fig. 1347.—Kochers operation. {Koclier.) Kochers operation sounds formidable, but innervation is well preserved andthe after-results are remarkably good. If partial resection is sufficient Kochersmethod permits the anterior part of the capsule, the subscapular muscle andthe coraco-humeral Hgament to remain uninjured, thus avoiding subsequentdislocation. Excision Shoulder.—A rational method of resection must comply with thefollowing conditions: Catterina (Zentralblatt fiir Chir, 1906, No. 2). 1. It must be safe and must hazard no important structures. 2. It must be easy. 3. It must afford a good view of all parts of the joint cavity. 4. It must be suitable to all cases requiring resection. Catterina endeavors to fulfil these requirements by temporary resection ofthe outer third of the clavicle, thus obtaining free exposure of the joint andavoiding injury to the deltoid and to the circumflex nerve
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