. A practical treatise on fractures and dislocations . e hasbeen regarded by Yidal (de Cassis), Mal-gaigne, and others, as only subacromial,and as a variety of the dislocation back-wards, differing from that in which thehead of the bone occupies a positionunderneath the spine. But as I can seeno difference except in the degree orextent of the displacement, I prefer notto regard the distinction made by thesesurgeons. Symptoms.—The signs of this acci- subspinous dislocation, dent are, a projection under the spine of the scapula, produced by the head of the bone, the head beingobedient to the mot
. A practical treatise on fractures and dislocations . e hasbeen regarded by Yidal (de Cassis), Mal-gaigne, and others, as only subacromial,and as a variety of the dislocation back-wards, differing from that in which thehead of the bone occupies a positionunderneath the spine. But as I can seeno difference except in the degree orextent of the displacement, I prefer notto regard the distinction made by thesesurgeons. Symptoms.—The signs of this acci- subspinous dislocation, dent are, a projection under the spine of the scapula, produced by the head of the bone, the head beingobedient to the motions of the arm; a corresponding depressionin front and under the outer extremity of the acromion process; awide space between the head of the bone and the coracoid process, intowhich the fingers may be pushed deeply; the axis of the shaft of thehumerus directed upwards and outwards toward a point posterior tothe glenoid fossa; the arm laid against the side of the body, and car-ried forwards across the chest; the humerus rotated inwards, unless IT*. 1 Sir A. Cooper, op. cit., p. 354. 566 DISLOCATIONS OF THE SHOULDER. the subscapularis muscle is torn; immobility, but the motions of thearm are not generally so much impaired as in either of the other dis-locations; and finally, as in all other dislocations of the humerus, thehand cannot be laid upon the opposite shoulder while the elbowtouches the side or front of the chest. In Parkers case the elbowwas thrown outwards, although the arm was carried very much acrossthe chest. Desclauxs patient held his hand upon his head, with hisarm horizontally across his body. Usually the diagnosis will be easily made, but Sir Astley relatesone case in which, on the morning following the accident, a surgeonwas unable to discover the dislocation, and on the seventeenth dayBransby Cooper failed to make the diagnosis; nor indeed, on thetwenty-third day did Sir Astley himself determine that it was a dis-location, until he had unexpectedly reduced
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