Remarks on excision of the shoulder-joint : read in the Section of Surgery / by William Stokes.

  • Stokes, Sir William, 1839-1900.
Date:
1883
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Licence: Public Domain Mark

Credit: Remarks on excision of the shoulder-joint : read in the Section of Surgery / by William Stokes. 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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    [ Reprinted for the Author from the British Medical Journal, Nov. roth, 1883.] REMARKS ON EXCISION OF THE SHOULDER-JOINT. Read in the Section of Surgery. By WILLIAM STOKES, F.R.C.S.I., Professor of Surgery in the Eoyal College of Surgeons, Ireland. Among the operative measures as regards the merits of which sur- gical opinion is undergoing change, resection of the shoulder must be mentioned. It has recently been stated by a recognised authority, Mr. Holmes, that the results obtained after this operation are “ pro- bably inferior, certainly not superior, to those of natural ankylosis,” and that, for this latter condition, “no cutting operation is justifi- able.” This view is one we should be slow to endorse, for now there are few surgeons of operative esperience, and who understand the principles that should guide the after-treatment of such cases, who would not be inclined to say that the results obtained after this operation are not only satisfactory, but, in truth, as a rule, and that whether done for injury or disease, in childhood or adult life, are superior to those obtained after most of the other resections of joints. For example, the fact of the patient being an adult need not, as in the majority of other excisions of joints, excepting, perhaps, that of the elbow, deter the operator from entertaining favourable anticipations as to the result. There is, if correctly performed, less shock, diffi- culty, haemorrhage, risk of wounding important nerves, and a greater probability of obtaining a freely movable false joint, than after any other similar operation. It is not difficult to understand the dis- repute into which the procedure fell, justifying, perhaps, the remark quoted already of Mr. Holmes, when it was performed by such methods as those of Moreau, Manne, Sabatier, Morel, Lisfranc, Nelaton, and others—operations long since consigned to a well- deserved oblivion, and when lengthened fixation of the limb was rigidly enforced after the excision. The remarkable change for the better in the results now obtained is undoubtedly due to the aban- donment of flap-methods of operating, to the adoption of the Ollier or Langenbeck-Ollier line of incision, to antisepticism, promoting thereby rapidity of union; and lastly, and perhaps as regards the ultimate result most important of all, to the early commencement of passive movements, exercises of the arm, and shampooing, which so materially aid in preventing the formation of fresh internal ad- hesions, and promoting restoration of muscular power. If the adop- tion of judiciously directed gymnastic exercises and shampooing be had recourse to at an early date after the operation, an all-important factor in the after-treatment of such cases, the good results above indicated, and which should be hoped for in all instances, can reasonably be expected, and that not only in early but in adult periods of life. I can best emphasise these statements by relating—which I shall do with all possible brevity—the principal facts connected with three cases of interest in which resection of the shoulder-joint was indicated.