A treatise on orthopedic surgery . scribed. RECURRENT DISLOCATION OF THE SHOULDER. Recurrent dislocation of the shoulder is in most instances asequel of traumatic dislocation. The cause of the instability isusually laxity of the capsular ligament and weakness of the sup-porting muscles, the result, it may be, of too early use of the armafter the accident. In rare instances greater derangement of thejoint caused by fracture of one or other of the articulating sur- 506 OETEOPEDIC SUBGEBY. faces, rupture or displacement of ligaments or muscles, or per-manent paralysis of the deltoid muscle may be
A treatise on orthopedic surgery . scribed. RECURRENT DISLOCATION OF THE SHOULDER. Recurrent dislocation of the shoulder is in most instances asequel of traumatic dislocation. The cause of the instability isusually laxity of the capsular ligament and weakness of the sup-porting muscles, the result, it may be, of too early use of the armafter the accident. In rare instances greater derangement of thejoint caused by fracture of one or other of the articulating sur- 506 OETEOPEDIC SUBGEBY. faces, rupture or displacement of ligaments or muscles, or per-manent paralysis of the deltoid muscle may be present. The displacement, which may be partial or complete, recurs atintervals and is a very serious disability. —If the patient is seen immediately after a dis-placement and if the dislocation has recurred but a few timesand at long intervals, it may be inferred that the disability isthe result of simple laxity of the capsule and of muscular weak-ness. In such cases a period of fixation followed by massage Fig. 334. Bilateral congenital pronation of the forearms. and exercise of the atrophied muscles may result in cure. Thepatient should be carefully questioned as to the particular move-ments of the arm that are likely to cause the displacement,which is, as a rule, forward beneath the coracoid process. Mostoften elevation and abduction seem to be the predisposing move-ments that should be restrained. A simple and often an effective DEFORMITIES OF THE UPPEB EXTREMITY. 507 means of treatment is the application of a shoulder-cap ofcanvas that fits closely about the shoulder and upper arm. Thisis held in place by bands crossing the body and buckled beneaththe other arm; from the lower border of the cap one or morebands pass downward and are attached with the braces to thetrousers, so that elevation of the arm is restrained, before thepoint of instability is reached. ^—If these milder measures are ineffective, an opera-tion to reduce the size of the lax
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