A system of surgery . readily to be seenand felt on raising the arm from theside. If the great tuberosity be inits proper position, and this pan bedetected even in fat shoulders, thehead of the humerus must be in themust be made when the greatthe dislocated head, and the con-verse does not necessarily hold true that when the tuberosity hassunk inwards dislocation must have taken place; for in fractureof the anatomical neck of the humerus, with displacement, this mayoccur, the head still remaining in the glenoid fossa. The latter con-dition is so rare, however, as hardly to need mention, and I
A system of surgery . readily to be seenand felt on raising the arm from theside. If the great tuberosity be inits proper position, and this pan bedetected even in fat shoulders, thehead of the humerus must be in themust be made when the greatthe dislocated head, and the con-verse does not necessarily hold true that when the tuberosity hassunk inwards dislocation must have taken place; for in fractureof the anatomical neck of the humerus, with displacement, this mayoccur, the head still remaining in the glenoid fossa. The latter con-dition is so rare, however, as hardly to need mention, and I do nothesitate to look upon the position of the tuberosity of the humeruswith regard to the acromion, as the key to the question of disloca-tion of the shoulder. The conditions which most closely simulate dislocations areas follows :—(1) Atrophy of the deltoid muscle from injuries tothe circumflex nerve, or too long fixation after accident, or indisease of the articulation ; (2) separation of the upper epiphysis of. Pi 386.—Attitude of the Arm in Sub-spinous Dislocation. glenoid cavity. Exceptionstuberosity is separated from DISLOCATIONS OF THE SHOULDER. 973 the humerus; (3) fracture of the surgical neck of the humerus;(4) fracture of the anatomical neck of the humerus; (5) fractureof the neck of the scapula ; and. (6) fracture of the great tuberosity. Confusion frequently arises regarding atrophy of the deltoid,especially as this condition may follow a properly reduced marked flattening of the shoulder closely simulates displacement,but the great tuberosity of the humerus will readily be felt beneaththe acromion projecting in its normal position, and passive motionmay be free. Separation of the epiphysis should be suspected if an apparentdislocation of the shoulder be brought to the surgeon in a patientunder twenty years of age. The line of separation will be belowthe great tuberosity, which is part of the upper epiphysis, andmaintains its normal position.
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