CHRONIC ARTHRITIS OF THE SHOULDER.--, We meet, in practice, with tvt o forms of' chronic arthritis of the shoulder. The first of these oc curs as an example of slow inflammation passing into either articular caries or anchylosis of the joint, and is analogous to the well-known scrofulous disease of the hip. The second furnishes us with a specimen of a chronic disease, which the writer has elsewhere in this work denominated chronic rheumatic arthritis t ; a disease, the effects of which are to be traced in all the articulations, but its peculiarities are in no joint better exemplified than when the shoulder becomes the seat of it. We shall first treat of the abnornal ap pearances produced by the disease we call simple chronic arthritis of the shoulder ; se condly, we shall describe those which belong to chronic rheumatic arthritis of the same arti culation: While the two chronic diseases of the hip, namely, the scrofulous affection and the chronic rheumatic arthritis of this joint, have of late years attracted much attention from the profession, it appears to the writer of this article that the corresponding diseases of the shoulder joint have been much overlooked. He hopes, therefore, he shall be excused if he deems it necessary to' enter into more than ordinary details relative to the two chronic affections of the shoulder joint, which he will now endeavour faithfully to delineate.
Simple chronic arthritis of the shoulder may be the result of a sprain or contusion : the synovial and fibro-synovial structures are in this case principally affected. If, however, the inflammatory action be not arrested, the bones, as well as their cartilaginous incrusta tions, become ultimately engaged, and true articular caries is established. The disease sometimes begins in the shoulder joint, with., out the patient being able to assign any cause for it ; and in this case it may have a consti tutional origin, and be the result of strum, or acute rheumatism, which last having sub sided in the other joints, has concentrated itself on this one articulation, assuming the form of an articular caries. We have known
it also appear in a young female during the convalescence from a long-continued gastric fever.
first symptoms the patient suffers from, who is affected with simple chronic arthritis, or articular caries of the bones which enter into the formation of the shoulder joint, is a sensation of weight, weari ness, and aching in the affected arm. These signs of the disease are at first not constantly present ; they appear and then disappear, to return again in some days. Some stiffness in moving the affected am is next complained of, to which is soon added pain, which the patient says is deeply seated in the joint, and which is augmented by using the articulation, or when the articular surfaces are pressed against each other, These symptoms are seldom so severe as to prevent the patient from following his ordinary occupations..
So far the disease may be said to be merely in its commencement ; but very soon we ob serve it to pass into the second stage, when it may be discovered, on minute inquiry, that there is some sympathetic disturbance of the system— some heat of skin and slight acce leration of the pulse, On examining the affected joint, we observe that the patient habitually carries it higher than the opposite shoulder, and the clavicle at the affected side is observed to pass, as it were, obliquely upwartls and outwards, the adipose and cellular tissue, as well as all the muscles around the shoulder joint waste. The deltoid muscle, in a state of atrophy, appears stretched longitudinally, and the affected shoulder to have lost much of its normal roundness. The acromion process projects (see fig. 427.), and the arm of the affected side appears, and is usually found, on comparative measurement, to be really lengthened ; the anterior fold of the axilla is deepened by the descent of the humerus from the glenoid cavity. The pain increases, and extends downwards from the shoulder to the inside of the elbow and wrist.