. Modern surgery, general and operative. t Dislocation.—Habitual or recurrent dislocationof the shoulder, following an original traumatic dislocation, results usuallyfrom a slight or trivial force. It is apt to take place when the arm is in ab-duction, slight rotation frequently being necessary. In some cases rotationwill produce a dislocation while the arm is near the side of the body. Littleis known of the frequency with which these cases occur, but they are probablymuch more frequent than is generally supposed. The frequency of the recur-rences in the individual cases varies widely. In some
. Modern surgery, general and operative. t Dislocation.—Habitual or recurrent dislocationof the shoulder, following an original traumatic dislocation, results usuallyfrom a slight or trivial force. It is apt to take place when the arm is in ab-duction, slight rotation frequently being necessary. In some cases rotationwill produce a dislocation while the arm is near the side of the body. Littleis known of the frequency with which these cases occur, but they are probablymuch more frequent than is generally supposed. The frequency of the recur-rences in the individual cases varies widely. In some they occur more or lessregularh every two or three years, while in others they have been known totake place daily and even several times a day. In most cases in the intervalsbetween the recurrences the joint functionates normally without difficulty,although the patient fears abduction because of its influence in favoring arecurrence. In rare cases pain persists a long time after each dislocation, so Dislocation of the Elbow-joint 759. Fig. 464.—Dislocation of both bones of the fore-arm backward. that if the recurrences are frequent, the patient may be compelled to give upwork. ^The essential cause is a relaxation of the capsule at the site of theoriginal tear, produced by the addition to the old or original portion of capsuleof a new or cicatricial portion bridging over the gap between the margins ofthe tear produced by the first dis-location. The failure of thesemargins to unite closely is due tothe repeated emergence of thehumeral head forcing them apartbefore union is complete. Thedefects in the head of the humeruswhich have been found at autopsyand operation have, probably, onlya slight and secondary causal im-portance, while the fractures of thegreater tuberosity of the humerussometimes occurring in dislocationsof the shoulder are probably notfollowed by recurrent — Excision of thehead of the humerus has beenabandoned in these cases. C
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