. A practical treatise on fractures and dislocations. rect con-tact with the head of the humerus. In none of Jossels four caseswas the normal communication between the cavity of the joint andthe subscapular bursa found to be enlarged ; in one the subcoracoidbursa communicated with the joint, and in one the tendon of thelong head of the biceps was ruptured, and its torn end had becomefixed in the bicipital groove. In two of the cases a small defect withsmooth edges was found in the capsule below the tendon of the sub-scapularis, and in the others the capsule appeared thinned at the samepoint. A
. A practical treatise on fractures and dislocations. rect con-tact with the head of the humerus. In none of Jossels four caseswas the normal communication between the cavity of the joint andthe subscapular bursa found to be enlarged ; in one the subcoracoidbursa communicated with the joint, and in one the tendon of thelong head of the biceps was ruptured, and its torn end had becomefixed in the bicipital groove. In two of the cases a small defect withsmooth edges was found in the capsule below the tendon of the sub-scapularis, and in the others the capsule appeared thinned at the samepoint. Apparently this indicated the place at which the head of thehumerus escaped through tlie capsule at the time of the first dislo-cation. The cavity of the joint was greatly enlarged by the changes in thecapsule; in the first its capacity was 90 cubic centimetres, as against28 in a normal joint, and its length along the upper portion was 10centimetres instead of the normal IV^. Jiissel: Deutsche Zeitschritt Iiir Chiiurj;ie, 1S80. vol. xiii. p. 1(> Recurrent or habitual dislocation of theshoulder, showing the opening into the sub-acromial bursa. (JbssEL.) 490 DISLOCATIONS: This condition of the capsule, aided by the withdrawal of the con-trol and support normally supplied by the supraspinatus and infra-spinatus, muscles, seems entirely adequate to explain the easy recur-rence of the dislocation, and the recent cases of relief by operativeshortening of the anterior portion of the capsule are corroborative ofthe opinion. Gangrene of the limb may ensue upon the rupture of the principalvessels, or even upon extensive laceration and violent inflammatoryreaction ; and paralysis of one or several muscles may manifest itselfimmediately or only after the limb is again brought into use, the resultof injury to nerve trunks or of contusion of the muscle itself, or ofcompression of the nerve by a cicatricial band as in Miillers case-quoted above, p. 485. CHAPTER XXX. THE PATHOLOGY OF UNRE
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