File:Lectures on orthopedic surgery (1899) (14590106849).jpg

Identifier: lecturesonortho00ridl (find matches)
Title: Lectures on orthopedic surgery
Year: 1899 (1890s)
Authors: Ridlon, John, 1852-1936 Thomas, Hugh Owen, 1834-1891 Jones, Robert, joint author
Subjects: Orthopedics
Publisher: Philadelphia, E. Stern & Co., Inc.
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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of the coursethe diseased shoulder had gone through. The factswere briefly these : The boy fell from the box of abrougham upon his shoulder ; it was painful and swol-len. The family-doctor called next day, prescribedrest and evaporating lotions, and after a weeks attend-ance left his patient with a few general instructions. Ina fortnight after the accident he was able to use hisshoulder, but with some discomfort. He always com-plained of pain on lying upon the joint. Examinedtwo months later by an experienced surgeon, disloca-tion was pronounced, to the discredit and humiliationof the local practitioner, who fully believed he hadmade a serious initial error. In this case as in others,the differential diagnosis from an old traumatic dis-placement was not difficult. Ankylosis was complete,which is rarely the fact in neglected luxation. The muscular shrinking was more marked, the headof the bone less really displaced, and the coracoid moreprominent than would have been the case in an old
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Fig. 192.—Showing muscular atrophy in shoulder-joint disease. 234 dislocation. How important, therefore, it is, both forthe sake of the patient and the previous attendant,that the differences and the similarities between thetwo conditions should be noted: for it must be em-phasized that tuberculous arthritis of the shoulderwithout suppuration, often results in ankylosis, suchankylosis being an accompaniment of the pathologicdisplacement. The differential diagnosis of traumatic cases is mate-rially aided by the history of the injury, and, althoughrheumatism may attack an injured joint, too muchcredit must not be given to the rheumatic theory. Tu-bercular osteitis should not be mistaken for rheumatismbecause of the insidious onset and absence of earlyinvolvement of the soft parts. When shrinking of the muscles is extensive, and incases that have experienced no pain, the part in appear-ance resembles certain spinal and traumatic palsies. Inparalysis, however, there is abnormal passive

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