Observations upon chronic rheumatic arthritis of the shoulder / by Robert W. Smith.

  • Smith, Robert William, 1807-1873.
Date:
1853
Catalogue details

Licence: Public Domain Mark

Credit: Observations upon chronic rheumatic arthritis of the shoulder / by Robert W. Smith. 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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    posterior inferior region of the elevated head of the hurnerus. The tendons of the four capsular muscles had lost their at- tachments to the tubercles, the lesser of which processes had become nodulated, and so much enlarged as to have ob- literated that portion of the bicipital groove, of which, in the normal state, it forms the internal boundary. The intra- articular portion of the tendon of the biceps had nearly alto- gether disappeared ; about a quarter of an inch of it, however, still remained connected to the glenoid ligament; its ex- tremity was smooth and rounded off, like that of the bone of a stump; it was larger than natural, and, along with the corres- ponding portion of the glenoid ligament (which was loosened from its attachment), was laid down, as it were, upon the upper part of the glenoid cavity, between which and the head of the humerus (with the intervention of the capsule), it was com- pressed. The lower portion of the tendon was adherent to the inferior part of the bicipital groove, and to the remains of the neighbouring portion of the capsular ligament. The acromion, about three-quarters of an inch from its ex- tremity, was divided into two portions, which were held toge- ther solely by the fibrous structure which invests the upper surface of the process; but this tissue was so much stretched, that the detached portion was separated from the remainder of the acromion by an interval of three-qviarters of an inch. The under surface of the entire process was denuded of perios- teum and covered with an ivory-like structure, which was also found investing the articular surfaces of the acromio-clavicular joint. The lower part of the glenoid cavity (which was still covered with cartilage) was completely abandoned by the head of the humerus. The remainder of the socket presented the appearance of ivory, which manifestly must have been estab- lished before the head of the bone had perforated the capsule. The resemblance which this case bears to that detailed by Professor Fergusson cannot fail to strike the reader. In each he will remark the elevation of the head of the humerus; its contact with the inferior surface of the acromion process; the deficiency in the capsular ligament, in consequence of which the head of the bone was found lying immediately under the deltoid muscle; the adhesion of the tendon of the biceps to the bicipital grove; the disappearance of its intracapsular por- tion, and the interposition of the capsule between the upper part of the glenoid cavity and the head of the humerus. We must, therefore, refer them to the same category, and as the » See Plate II.