. Manual of operative surgery. me this difiiculty bychiseling off from the main bone a shell of bone and retracting it along with itsperiosteal and tendinous attachments. The method has many good featuresin addition to its simplicity that the author has applied to the shoulder-joint. Expose the shoulder through the Oilier incision. Divide the periosteumof the humerus along the outer edge of the bicipital groove. Place a chiselin position with its edge against the outer margin of the bicipital groove and cutthrough the great tuberosity (Fig. 1344). Reflect the detached shell of bonewith all its
. Manual of operative surgery. me this difiiculty bychiseling off from the main bone a shell of bone and retracting it along with itsperiosteal and tendinous attachments. The method has many good featuresin addition to its simplicity that the author has applied to the shoulder-joint. Expose the shoulder through the Oilier incision. Divide the periosteumof the humerus along the outer edge of the bicipital groove. Place a chiselin position with its edge against the outer margin of the bicipital groove and cutthrough the great tuberosity (Fig. 1344). Reflect the detached shell of bonewith all its connections outwards. Lift the long tendon of the biceps outwards. EXCISION SHOULDER 1087 With the chisel cut the lesser tuberosity free from the shaft of the inwards the shell of bone, with its periosteal connections and with thelong head of the biceps. Dislocate the head of the humerus into the wound,at the same time severing its posterior attachments with periosteal elevator orscissors as already Fig. 1344.—Authors method of excision of shoulder. A. External shell of bone (major tuberosity held outwards by chisel); B. Internal shell of bone retracted inwards; C. Bicipital groove. After the active operation is completed, examine the shells of bone whichremain attached to the periosteum. If they show evidences of disease, removethem; if not, replace them. When the shells of bone are replaced, arrange themin such a manner that the long tendon of the biceps will remain superficial tothem. W. T. Reynolds showed the author a method (which was apparently devisedby A. W. McArthur) for exposing the shoulder through the axilla. From apoint a short distance below the coracoid process make an incision downwardsand slightly outwards until the lower edge of the anterior axillary fold is divided io88 SHOULDER and the pectoralis major is exposed. Divide the pectoraHs major at right anglesto its tibres and about 1*2 inches from its insertion. This gives excelle
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