Chronic rheumatic arthritis of the shoulder-joint / [Robert Adams].

  • Adams, Robert, 1791-1875.
Date:
[1849?]
Catalogue details

Licence: Public Domain Mark

Credit: Chronic rheumatic arthritis of the shoulder-joint / [Robert Adams]. Source: Wellcome Collection.

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    On examining the joint after death the accident was found to be a dislocation of the long head of the biceps from its groove, unac¬ companied by any other injury. The tendon was entire, and lay en¬ closed in its sheath on the lesser tubercle of the humerus; the capsule was but slightly ruptured ; the joint exhibited extensive traces of inflammation; the synovial membrane was vascular and coated with lymph ; recent adhesions were stretched between different parts of its surface, and ulceration had commenced on the cartilage covering the humerus, where it came in contact with the under surface of the acromion; the capsule was thickened and adherent, and in time pro¬ bably anchylosis of the joint would have taken place. Observations on Mr. Soderi’s Case_The symptoms the case pre¬ sented immediately after the accident occurred do not appear to me to be such as we should rationally expect to follow a dislocation inwards of the long tendon of the biceps. For it is stated that the patient could raise his arm over his head immediately after the ac¬ cident occurred, and we are totally at a loss to account for “ the crepitating sensation” experienced under the fingers of the surgeon examining the joint (“simulating a fracture, but in reality caused by the friction of the head of the humerus against the under sur¬ face of the acromion”). We could hasily imagine such symptoms to have existed if we had been informed that the joint had been pre¬ viously diseased, and that all those structures normally interposed between the head of the humerus and under surface of the acro¬ mion had been absorbed. It is stated, no doubt, that the capsule was slightly ruptured; but this rupture found on dissection, if it really was the immediate result of accident, would not account to us for the fact of crepitation of rubbing surfaces having occurred between the under surface of the acromion and summit of the hu¬ merus. On the other hand, the symptoms, including this crepita¬ tion, strongly resembled those which ordinarily present themselves in cases of chronic rheumatic arthritis of the shoulder-joint, viz.: the flattening observed on the outer and posterior part of the shoulder- joint; the head of the bone being drawn higher up in the glenoid cavity than it should be; the impossibility of raising the arm from the side, except for a short distance; the statement that “the head of the humerus was also unduly prominent in front, almost to the amount of a partial dislocationall these, it may be observed, are the very symptoms which ordinarily present themselves in the usual case of chronic rheumatic arthritis, when it appears in the shoulder- joint. It is to be remarked that although in this case the man had met with an accident, to which all his symptoms were attributed, it is stated that he was of a rheumatic habit, and that “ inflammatory action of that character was soon established in the joint, so that the peculiar symptoms of the injury were masked by those of gene¬ ral articular inflammation, which added greatly to the man’s suffer¬ ings and to the difficulty of the diagnosis.” The fall on the shoulder, alluded to in the history of the case,