The nomenclature of scapulo-humeral dislocations / by Joseph Bell.

  • Bell, Joseph, 1837-1911.
Date:
1863
Catalogue details

Licence: Public Domain Mark

Credit: The nomenclature of scapulo-humeral dislocations / by Joseph Bell. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    In the following exposition of this plan of nomenclature, I intend to confine myself to the discussion of the purely anatomical points deduced from the normal anatomy and from dissections of old dis- locations, and shall not do more than merely glance at one or two of the more important symptoms. As I have never had the opportunity of dissecting for myself a recent or even an old unreduced dislocation of the humerus, I have had to avail myself of the dissections of others, as recorded in sur- gical works, especially of the classical treatises of Sir Astley Cooper and Malgaigne; but I have had ample opportunities of satisfying myself of the correctness of the main facts of my views as far as normal anatomy is concerned in them. The principle of my plan of division, which I will call Second Anatomical plan, is, instead of considering only the relations of the humeral head as a whole to the various scapular prominences, to add to this an inquiry as to what special portion (ridge or groove) of the humeral head is applied to what portion of the scapula ? I must here premise a single word of anatomical description regarding the posterior aspect of the head of the humerus. We need here consider only the posterior aspect; for in all dis- locations of the humerus, except where complicated with fracture or lesion of the integuments, as in machinery injuries, the bend of the arm still looks (in general terms) forwards. We have, then, closely bounding the articular surface of the head, the anatomical neck (Fig. 1, A b c), extending backwards, downwards, and inwards. Immediately outside of and below the upper half of this line (a b), we find the two lower muscular facets of the greater tuberosity for the infraspinatus (e) and teres minor (f). Internal to the lower of these facets, we see, in all well-marked bones, a groove which I think lias not hitherto met with the attention it deserves from surgeons (b d). This groove runs nearly parallel to the axis of the shaft of the humerus, and joins the anatomical neck (a-bc) at b, at an angle of about 50°. This angle varies with the angle formed by the axis of the head with the axis of the shaft at different ages and in different bodies. This groove I shall have to mention occasionally under the name of the posterior groove of the humerus. Now, the great principle of my plan of nomenclature is, that in all forms of dislocation ot the humerus in which the injury has been comparatively moderate, and the muscles only stretched, not torn, these two grooves, the anatomical neck and the posterior groove, are the parts of the humeral head which alone can be in contact with the scapula. Their being in contact with the scapula, then, gives us at once a distinction between the more usual and simple forms of injury and those of greater gravity and rarity. But we have here the means of making yet a further subdivision, by asking on what part of the scapula do these grooves rest ? I shall endeavour to prove that the anterior glenoid border, and the