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CHAP. XXI. Of a Dislocated shoulder.
THe shoulder is easily dislocated, because the ligaments of its de∣articulation are soft and loose; as also for that the cavitie of the shoulder-blade is not very deepe; and besides, it is every where smooth and polite, no otherwise than that of the shoulder-bone, for that it is herein received. Adde hereunto, that there is no in∣ternall * 1.1 ligament from bone to bone, which may strengthen that dearticulation, as is in the legge and knee. Wherein notwith∣standing, we must not thinke nature defective, but rather admire Gods providence in this thing; for that this articulation serves not onely for extension and bending, as that of the Elbow, but besides, for a round or circular motion, as that which carries the arme round about, now up, then downe, according to each difference of site. The shoulder-bone, which Hippocrates cals the Arme-bone, may be disloca∣ted * 1.2 foure manner of waies; upwards, downe-wards, or into the Arme-pit, for∣wards and outwards, but never backwards, or to the hinde part. For, seeing that there the cavitie of the blade-bone, which receives the head of the arm-bone, which Hippocrates cals a Joynt, lyes and stands against it; who is it that can but imagin * 1.3 any such dislocation? In like sort it is never dislocated inwardly, for on this part it hath the flesh of a strong muscle, termed Deltoides, lying over it, besides also the backe and acromion of the Blade, and lastly, the anker-like or beake-like processe, all which foure hinder this joynt from slipping inwards. Now Hippocrates saith, that he hath only seene one kinde of Dislocation of this bone, to wit, that which is downe-wards or to the arme-pit: and certainly it is the most usuall and frequent, wherefore we intend to handle it in the first place. When the shoulder is dislocated down-wards into the Arme-pit, a depressed cavitie may bee perceived in the up∣per * 1.4 part of the joynt; the acromion of the Blade shewes more sharpe and standing forth than ordinarie, for that the head of the shoulder-bone is slipt downe, and hid under the arme-pit, causing a swelling forth in that place; the Elbow also casts it selfe (as it were) outwards, and stands further off from the ribs; and though you force it, yet can you not make it to touch them; the Patient cannot lift up his hand to his care on that side, neyther to his mouth, nor shoulder. Which signe is not peculiar to the luxated shoulder, but common to it, affected with a contusion, fracture, inflammation, wound, abscesse, scirr••us, or any defluxion upon the nerves, arising out of the vertebrae of the neck, and sent into the arme: also this arme is lon∣ger than the other. Lastly (which also is common to each difference of a luxated shoulder) the Patient can move his arme by no kinde of motion without sense of paine, by reason of the extended and pressed muscles, some also of their fibres be∣ing broken. There are sixe wayes to restore the shoulder luxated down-wards into the arme-pit. The first is, when it is performed with ones fist, or a towell. The se∣cond, * 1.5 with a clew of yarne, which put under the arme-pit, shall be thrust up with ones heele. The third, with ones shoulder put under the Arme-hole, which maner, together with the first, is most fit for new and easily to be restored luxations, as in those who have loose flesh, and effeminate persons, as children, eunuches, and wo∣men. The fourth, with a ball put under the Arme-pit, and then the Arme cast over a piece of wood held upon two mens shoulders, or two standing posts. The fifth, with a Ladder. The sixth, with an Instrument, called an Ambi. Wee will describe these sixe waies, and present them to your view.