Anatomy, descriptive and surgical / by Henry Gray ; with an introduction on general anatomy and development by T. Holmes ; the drawings by H.V. Carter ; with additional drawings in later editions ; ed. by T. Pickering Pick.

Henry Gray

Date:: 1883

Credit: Anatomy, descriptive and surgical / by Henry Gray ; with an introduction on general anatomy and development by T. Holmes ; the drawings by H.V. Carter ; with additional drawings in later editions ; ed. by T. Pickering Pick. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

986/1036 (page 982)

$TTIJ'J ATiM. 130. Clavicle.—The line of the davicle and the projection of the joint at either end can always be felt, even in the fattest persons. Its direction is not perfectly horizontal, but slightly inclined downwards, when the arm hangs quietly by the side. When the body lies fiat on the back, the shoulder not only falls back, but rises a little, the weight of the limb being taken oif. Hence the modern practice of treating fractures of the clavicle (in the early stage) by the supine position. On the front surface of the clavicle, not far from its acromial end, there is in many persons of mature age a spine-like projection of bone. So far as I know, it has not been described. A gentleman, himself a surgeon, showed me an instance in his own person. He suspected it was an exostosis. As a rule the acromio-clavicular joint forms an even plane. But there is sometimes a knob of bone at the acromial end of the clavicle; or it may be only a thickening of the fibro-cartilage, sometimes existing in the joint. In either case this relief might be mistaken for a dislocation, or even for a fracture. A reference to the other shoulder might settle the question. [Being subcutaneous throughout, the clavicle can readily be seized and ex- amined for fracture, syphilitic nodes, etc. If before a glass the arm be swung round, raised and lowered, the shoulder be shrugged, etc., we shall appreciate the fact that this is the only bony connection the arm has with the body, and to what a very large extent it is movable, the sterno-clavicular joint being the pivot.] 131. Bony Points of the Shoulder.—We can distinctly feel the spine of the scapula and the acromion, more especially at the angle where they join be- hind the shoulder. This angle is the best place from which to measure in taking the comparative length of the arms. In some shoulders, though very rarely, there is an abnormal symphysis be- tween the spine of the scapula and the acromion. There may indeed be two symphyses and two acromial bones, the acromion having two centres of ossifi- cation. These normal symphyses might be mistaken for fractures, until we have examined the opposite shoulder, which is sure to present a similar confor- mation.^ Tuberosities.—Projecting beyond the acromion (the arm hanging by the side), we can feci, through the fibres of the deltoid, the upper part of the hu- merus. It distinctly moves under the hand when the arm is rotated. It is not the head of the bone which is felt, but the tuberosities, the greater externally, the lesser in front. These tuberosities form the convexity of the shoulder. When the arm is raised, this convexity disappears ; there is a slight depression in its place. The head of the bone can be felt by pressing the fingers high up in the axilla. The absence of this prominence formed by the upper part of the humerus under the deltoid, and the presence of a prominence low in the hollow of the axilla, or in front, below the coracoid process, or behind, on the back of the scapula, bespeak dislocation of the head of the bone. In examining obscure injuries about the shoulder, it is worth remembering that, in the normal relation of the bones, and in every position, the great tuber- osity faces in the direction of the external condyle. The head of the bone faces very much in the direction of the internal condyle. It is worth remembering also that the upper epiphysis of the humerus includes the tuberosities; and that it does not unite by bone to the shaft, till about the 20th year. By making deep pressure in front of tlie shoulder, when the arm is pendent ' See Pruge on Ossa Acromialia ( Zeitschrift fur rationelle Medizin ), 3. Reihe, Bd. vii., 1850.$