. Manual of operative surgery. a-spinatus. Divide a portion of theorigin of the deltoid posteriorly (Fig. 1346). Push the finger along the lowersurface of the spine of the scapula, between the deltoid and the infra-spinatus RESECTION SHOULDER 1089 to the place where the infra-spinatus loses touch with the spine. Bluntly pushthe supra-spinatus away from the upper surface of the spine until the finger canbe hooked round the outer end of the spine. Step 3.—Method A.—With a chisel make an oblique section of the spine ofthe scapula, so that the acromion process and the whole crest of the scapularsp
. Manual of operative surgery. a-spinatus. Divide a portion of theorigin of the deltoid posteriorly (Fig. 1346). Push the finger along the lowersurface of the spine of the scapula, between the deltoid and the infra-spinatus RESECTION SHOULDER 1089 to the place where the infra-spinatus loses touch with the spine. Bluntly pushthe supra-spinatus away from the upper surface of the spine until the finger canbe hooked round the outer end of the spine. Step 3.—Method A.—With a chisel make an oblique section of the spine ofthe scapula, so that the acromion process and the whole crest of the scapularspine from which the deltoid arises are separated from the body of the dividing the bone it may be well to drill holes in the bone on each side ofthe line of section so as to be able conveniently to wire the fragments on com-pletion of the operation. Instead of boring holes, one may subperiosteallyresect a small fragment of bone on each side of the line of section, thus leaving Acromioclavic-ular joint Acromion .. IiG. 1346.—Kochers incision. (Kocher.) small flaps or tags of periosteum which may be sutured together. In dividinothe bone be careful not to injure the supra-scapular nerve as it goes through thegreat scapular notch. Method B.—Instead of cutting off the mass of the spine of the scapula,merely cut off, subcortically, that portion from which the deltoid arises. Step 4.—Turn downwards the flap of deltoid muscle with its bony attachments(Fig. 1347). This exposes very freely the outer and posterior surfaces of thehead of the humerus with the attachments. Rotate the arm outwards. Makea longitudinal incision down to the bone along the posterior margin of the bi-cipital groove and 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 struct
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