ACTJTE ARTHRITIS OF THE SHOULDER.—The symptoms of acute inflammation of the shoulder joint will be found to be similar to those we have elsewhere in this work described as being present, when some of the other large articulations have been affected by The patient will feel considerable pain in the shoulder joint, to the front of which he will point as the seat of his most acute suffering. This pain is aggravated by the slightest touch, or when any movement is communicated to. the joint. The patient himself carefully pre serves his arra immovably in one posture as he lies in bed, with his elbow abducted from his side, and his hand supported in the state of supination. Effusion of altered synovia, or purulent matter, rapidly takes place into the synovial sac of the articulation. There is much heat of the surface and tension of the skin. The pain which, as already mentioned, is felt on the front of the shoulder joint, soon ex tends down the arra to the inside of the elbow-joint, and the patient complains of spasmodic startings of the limb, and cederna of the whole extremity may supervene. The distention of the synovial sac of the articu lation increases, and the surgeon can discover a fluctuation along the anterior or posterior border of the deltoid region, and he may find it expedient, with the view of relieving pain and tension, to make an incision into the joint, and thus give exit to a large quantity of purulent matter. Irritative, or it may be in
some constitutions inflammatory, fever accom panies these symptoms, arid the patient may be carried off even before the period when the purulent matter shall have made its way to the surface; or the acute inflammation may subside into chronic arthritis, and articular caries of the shoulder joint be established, to run its subsequent cow.se as a chronic disease, The acute form of the disease only differs from the chronic in the former being more intense in its attack, and in being accompanied with swelling of the joint — in being more rapid in its course, and. more speedily pro ducing complete disouganisation of the arti cular textures.
Anatomical characters of arthritis of the shoal- der.—Very few opportunities are offered to the anatomist of witnessing the appearances which the several tissues of the shoulder joint pre sent when they have been the seat of acute inflammation ; we may, however, safely infer, that the articular structure of this joint will be altered in a similar manner in consequence of an attack of acute arthritis, as the corre sponding tissues in other joints have been already described.*