File:A practical treatise on fractures and dislocations (1912) (14782602774).jpg

Identifier: practicalt00stim (find matches)
Title: A practical treatise on fractures and dislocations
Year: 1912 (1910s)
Authors: Stimson, Lewis Atterbury, 1844-1917
Subjects: Fractures Dislocations
Publisher: New York, Philadelphia, Lea & Febiger
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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and felt beneath and behindthe acromion (Fig, 394), sometimes quite close to its normal position,sometimes much further back; in Gaillards at about an equal distancefrom the two ends of the spine of the scapula. The elbow is directedforward and a little outward and is markedly rotated inw^ard. Thisposition is noted in all and is evidently characteristic. Motion, activeand passive, is limited in all directions, especially outward rotation andadduction. Scudders and Cumstons electrical examination of the mus-cles showed little difference between the two sides; in one of mine themuscles supplied by the musculo-spiral and musculo-cutaneous nerveswere markedly paretic, in two all were norraalj and in one rotationof the forearm was Aveak, but its range was complete. In all mycases the condition was noticed at birth; in one the child cried when-ever the limb was handled, but after two months moved it voluntarily.In my fifth (doubtful) case, seen in 1886, the delivery was instru- XXX h< Oh
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(/) ^ o CONGENITAL DISLOCATIONS OF THE SHOULDER. 675 mental and very difficult; the child, now dead, was four years oldwhen I saw him; the attitude of the limb was similar to that abovedescribed, and all voluntary motion at the shoulder was lost; I classedit at the time as an ^ obstetrical paralysis/ The treatment in Gaillards case is interesting: Four times in thecourse of a week he made horizontal traction on the arm by means ofa weight of sixteen pounds, continued for fifteen or twenty minutes,and reinforced occasionally by traction with his hands. On the lastoccasion the head moved an inch and a half along the scapula to theedge of the glenoid fossa and was then thrown into it by a movementof leverage. It almost immediately came out again. The next dayit was again reduced and kept in place for an hour. Ten days laterit was again reduced, and the arm fixed by a bandage; this time thereduction persisted. Two years later the limb was found to havegained half an inch in length; the pa

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