The treatment of fractures . g. 144.—Examination of shoulder. Palpatingthe coracoid processes. Note the position of the handsand thumbs. shaft, there is probably no fracture unless there is one with impac-tion. If the humeral head does not rotate with the shaft, thenthere is a fracture. If crepitus is present, the diagnosis is con-firmed. After injury to the shoulder the following fracture lesionsmay be present, and are to be considered : fracture of the anatomical neck of the of the upper humeral racture of the surgical neck of the humerus. DIFFERENTIAL DIAGNOSI
The treatment of fractures . g. 144.—Examination of shoulder. Palpatingthe coracoid processes. Note the position of the handsand thumbs. shaft, there is probably no fracture unless there is one with impac-tion. If the humeral head does not rotate with the shaft, thenthere is a fracture. If crepitus is present, the diagnosis is con-firmed. After injury to the shoulder the following fracture lesionsmay be present, and are to be considered : fracture of the anatomical neck of the of the upper humeral racture of the surgical neck of the humerus. DIFFERENTIAL DIAGNOSIS 12/ In any one of these instances a dislocation of the humeralhead from the glenoid cavity may exist and complicate the case. Simple Dislocation of the Humeral Head, Subcoracoid (seeFig. 145).—The attitude is characteristic: the affected armis held flexed, with the elbow away from the side and the armrotated inward. The anterior axillary fold is lowered upon theinjured side. The long axis of the shaft of the humerus is. Fig. 145. — Dislocation of the left shoulder. Note the flat deltoid. Prominence undercoracoid. Direction of the long axis of the humeral shaft. Lengthening of upper arm. Leftnipple lowered. Anterior axillary fold lowered. inclined inward. The roundness of the shoulder is acromial process is prominent. The head of the humerusis out of the glenoid cavity, and most often lies under the cor-acoid process. The elbow can not be brought in front toward themedian line, nor can the hand of the injured arm be placed uponthe opposite shoulder. Active and passive movements at theshoulder-joint are greatly restricted. Measuring from the acro-mial process to the external epicondyle of the humerus, the 128 FRACTURES OF THE HUMERUS upper arm, in a subcoracoid dislocation, is lengthened. A softcrepitation may be detected in manipulating the shoulder, whichsimulates bony crepitus. Fracture of the Anatomical Neck (see Figs. 146, 147, 148,149, 150, 151).—Thi
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