Lecture of M. Berard at the Concours in Paris

1834 Boston Medical and Surgical Journal  
First Patient.-Luxation of the Humero-scapular Articulation, DOWNWARDS AND FORWARDS. The first patient presented to M. Berard (fils) was marked on the back of the thigh with a large cicatrix, the result of a burn carried to the third degree ; it was very irregular in form, but did not exhibit any tendency lo the formation of bridles, which led the speaker to lay down as a general principle, that cicatrices formed on the side of extension, have not the same tendency to the production of bridles
more » ... duction of bridles and retractions, as those which take place on the side of flexion. This was not the only injury ; the patient exhibited another, much more interesting, and to which the speaker immediately applied himself. The patient, in this case, was a mason, and while ascending a ladder, he fell from a considerable height on his left side. On getting up he felt a good deal of pain in that side and along the arm, but there was no loss of sensation. On examination of the injured limb, the following particulars were remarked, which leave no doubt of the nature of the affection. In the first place, the left arm hangs down by the side, and is longer than the opposite one by six or eight lines. This was ascertained by measuring the distance between the acromion process and the olecranon ; the height of the anterior parietes of the axilla seemed increased, and the arm projected from the side about three inches. On examining the axilla, it was easy to distinguish the presence of a solid body in that space. The motions of the joint are extremely limited (here the speaker entered into the study of the motions of the limb, but forgot rotation altogether), and if the surgeon acts upon it with the least force, he gives a great deal of pain. It was impossible to draw the arm away from the side, or to bring it forward without immense suffering to thé patient. On pressing the fingers over the surface of the shoulder-joint, a depression was felt on its superior parietes, along which the fibres of the deltoid muscles were drawn, tense and rigid. In the axilla, there was not that hollow which presents itself in a healthy stale, but the hand discovered a round, hard tumor, which followed the motions of the arm, and seemed to be continuous with the body of the bone. The nature of this afiection is easily gathered from the preceding symptoms ; it is a luxation of the humero-scapular articulation, downwards and forwards. Let us now endeavor to prove that it can be no other lesion than the one which we have indicated. In the first place, we say it is a luxation and not a fracture of the surgical head of the
doi:10.1056/nejm183410080110901 fatcat:zgeiuo6wwfdchmjj5zmv73koku