. American practice of surgery ; a complete system of the science and art of surgery . , must be a smooth,even, rounded surface. (From Dr. E. A. Codman.) SURGICAL DISEASES OF THE EXTREMITIES. 47 degree of existing inflaniination. In recent cases it is usually present; inold, quiescent cases it is absent. (2) Since the tuberosity cannot be made topass under the acromion, the point of slipping tenderness is not found. (3) Al>duction and external rotation of the humerus are limited to a greater or lessextent, usually so .much so that the tuberosity will not jjass Ijeneath tlieacromion. The ten
. American practice of surgery ; a complete system of the science and art of surgery . , must be a smooth,even, rounded surface. (From Dr. E. A. Codman.) SURGICAL DISEASES OF THE EXTREMITIES. 47 degree of existing inflaniination. In recent cases it is usually present; inold, quiescent cases it is absent. (2) Since the tuberosity cannot be made topass under the acromion, the point of slipping tenderness is not found. (3) Al>duction and external rotation of the humerus are limited to a greater or lessextent, usually so .much so that the tuberosity will not jjass Ijeneath tlieacromion. The ten degrees of free motion in which the function of the bursais not called into play, persist; if they do not, the true joint is inv(j]\-ed.(4) Beyond an arc of about ten degrees the scapula accompanies the humerus in S\Al^i\XoviX BuYSO-. Fig. 29. Fig. 30. Figs. 29 and 30.—Diagrammatic Sketch of a Horizontal Section through the Head of the Hu-meiais, to IncUcate the Lateral Extent of the Bursa, and the Necessity for its Existence to Allow theGreater Tuberosity to Rotate Beneath the Deltoid. Notice also how (Fig. 29) the tendon of theinfraspinatus is stretched around the head of the bone in the internal rotation, and how the tendon ofthe subscapularis is stretched around the head in the opposite direction in external rotation. (Fig. 30.)Tliis stretching occurs, not in the tendons themselves, wliich are verA^ short, but in the muscles, whichby their construction take up the slack of the capsule of the joint. It can be easily imagined how asimultaneous spasm of these muscles would lock tlie joint. (From Dr. E. A. Codman.) all its motions, whether active or passive. (5) The pain is often in the samedistribution as in the first type, and frequently occurs in the neck also. Inthe severe cases it closely resembles the pain
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