A labourer, Thomas Rooney, alt. 24, ap peared among the extern patients at the Richmond Hospital on Thursday, 8th June, 1818, seeking relief for some internal aihnent; we noticed the wasted condition of the right shoulder joint. We learned that about three years previously he had fallen on the right shoulder and injured it ; he applied for relief to an ignorant person called a bone setter, in whose hands he suffered severely, having been subjected to violent dragging, with the view, as he was told,'of reducing a sup posed dislocation of his shoulder ; violent in flammation of the joint succeeded, for the treat ment of which he was admitted into Steeven's Hospital. While in the house suppuration of the joint occurred, and purulent matter made an exit beneath the anterior fold of' the axilla, where the tendon of the pectoralis major is inserted into the humerus. The pain and swelling then became less, and he returned to the country, the abcess and sinus leading from it closed up, and lais general health became gradually as good as it had been before he met with the accident, and remained so until he became affected with the trivial ailment he now sought advice for as an extern patient at the Richmond Hospital.
The shoulder joint, on a superficial ex amination, might be said to resemble some hat the appearance presented in a case of an old unreduced axillary dislocation, but the resemblance was but slight. It is true that the acromion process stood out laterally, that the deltoid was flattened, that the anterior fold of the axilla was deeper than natural, and that the angular appearance the right shoulder presented was strongly contrasted with the natural rounded contour of the left shoulder joint ; but the head of the humerus could be felt underneath the acromion process ; the elbow, instead of being separated from the side as in disolcation, seemed habitually ap proximated to it. The biceps muscle, in consequence of the atrophied condition of the elevators of the extremities, lad double fluty to perform, and hence had been greatly hypertrophied at its lower part. The man
can hold the plough, and can perform all the under movements of the arm very well, but cannot elevate it, nor place his forearm be hind his loins.
In this ca.se the arm is hahitually approxi mated to the side, directed somewhat for. -wards, and strongly rotated inwards. The most striking features in the case are the wasted condition of the shoulder joint from the atrophy of the deltoid and articular muscles, and the extraordinary development of the lower part of the belly of the biceps the cause of which hypertrophy is easily un derstood.
We have seen cases in the living subject of perfect anchylosis of the shoulder joint, in wbich it seemed doubtful whether any short ening of the extrenaity existed. In these cases we must suppose that the head of the hu merus became directly consolidated with the surface of the glenoid cavity, and without the more usual union having been established between the upper extremity of the bone and the superincumbent processes.
One of the most important points which engages the attention of the practical surgeon, in the treatment of cases of diseased joints at the period when it is expected that a process of anchylosis is going on, is to preserve the affected limb in that position which will be found most convenient to the patient, when true bony anchylosis of the joint shall have been established ; for example, under such circumstances we take care to preserve the knee and hip joints extended, the ankle and elbow joint bent to a right angle ; but the shoulder joint, when anchylosis is taking place, may be left to nature, so far as the position of the limb is concerned, because the humerus in these cases habitually remains nearly parallel to the long axis of the body, somewhat rotated inwards ; and, in a word, in a position which will be found most favour able to the performance of those functions it shall be called uport to execute when the scapulo-humeral joint is in an anchylosed state.