Note 42 — Chapter XXXV · DISLOCATIONS.

The shoulder is liable to numerous injuries that produce disability. Pain in some of these conditions may be almost constant and spread upward to the neck and be aggravated by even passive motion. Loss of power varies from moderate paresis to complete paralysis. When the circumflex nerve is especially involved it is the deltoid which shows the effects. More severe injuries may involve the muscles of the arm and the forearm. Muscle atrophy may be greater than can ordinarily be accounted for by mere disease. In rheumatic patients a dry synovitis may be added to the other complications. Most of these features are due to traumatic neuritis. When aggravated they may result from rupture of nerves or cicatricial formations around them. The best treatment consists of immobilization for three or four weeks to favor nerve repair, counterirritation, especially with the flying cautery, over the roots of the branchial plexus, with massage, electricity, and even deep injections of strychnine to stimulate the paralyzed muscles. When paralysis is persistent and scar tissue seems to press upon nerves, exposure of the plexus and freeing its branches from all source of pressure will be necessary.