Handbook for the ship's medicine chest / by George W. Stoner ; prepared by direction of the Surgeon-General.

  • Stoner, George W.
Date:
1904
Catalogue details

Licence: In copyright

Credit: Handbook for the ship's medicine chest / by George W. Stoner ; prepared by direction of the Surgeon-General. Source: Wellcome Collection.

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    f After Ilelfrlch.] * Dislocation of the shoulder joint is a very common accident. It occurs as frequently as all other dislocations put together. The fre- quency is explained by the great latitude of motion of the joint, the shallowness of the socket, and the size and rounded shape of the head of the bone, the laxity of the capsular ligament, and the leverage exerted on the joint by the long bone. There are three chief forms of dislocation of the shoulder, (1) for- ward and downward below tin* collar bone, (2) directly downward into the armpit, and (3) backward on the shoulder blade. The symptoms and signs are pain, swelling, rigidity (stiffness), loss of power, fattening and angular appearance of the shoulder as compared with the other shoulder, abnormal situation of the head of the bones, and change in the axis of the long bone. (Fig. 23.) In the first variety, the most common of all, the head of the bone may be felt in front of the armpit and below the collar bone, and the elbow points outward and backward. In the second the head of the bone may be felt in the armpit, and the elbow points outward. In the third, tht' head of the bone may be felt on the back of the shoulder blade, the elbow points forward, and the forearm is thrown across the chest. Another valuable sign is that when the elbow is placed on the chest the patient can not place the hand of the injured side upon the opposite shoulder, or if the hand is placed on the shoulder the elbow can not be brought into contact with the chest. Treatment.—The treatment for the first variety (forward and downward) is as follows: Lay the patient down or let him sit on a chair: bend the forearm on the arm; press the elbow against the side of the chest and hold it there; rotate the arm outward by carry- ing the forearm outward; pull steadily on the arm and rotate inward by carrying the elbow upward and forward with forearm across the chest. While this is going on have an assistant place his hand in th(‘ armpit and press the head of the bone into place. For the second variety (directly downward into the armpit), place the patient on his back; remove your boot; place your heel in the armpit; grasp the wrist and pull steadily on the arm. If the dislo- cation is in the right shoulder, seat yourself on the right side of the patient and use your right foot; and if the injury is in the left shoulder, seat yourself on the left side and use your left foot. The same principles may be carried out bv seating the patient on a low chair and placing your knee in the armpit. Another method is to have an assistant stand upon a table and make counter extension with a towel, or a strong piece of soft cloth of any kind, passed under the armpit of the patient, while the oper-