CHAP. XXI. Of a dislocated shoulder.
THe shoulder is easily dislocated, because the ligaments of its dearticulation are soft and loose; as also for that the cavity of the shoulder blade is not very deep; and besides it is every where smooth and polite, no otherwise than that of the shoulder bone, for that it is herein received. Add hereunto, that there is no internal ligament from bone to bone,* 1.1 which may strengthen that dearticulation, as is in the leg and knee. Wherein notwithstanding, we must not think nature defective, but rather admire Gods providence in this thing; for that this articulation serves not only for extension and bending, as that of the elbow, but besides, for a round or circular motion, as that which carries the arm round about, now up, then down, ac∣cording to each difference of site. The shoulder bone, which Hippocrates cals the arm bone, may be dislocated four manner of ways, upwards, downwards, or into the arm-pit, forwards and out∣wards, but never backwards, or to the hinder part: For, seeing that there the cavity of the blade bone, which receives the head of the arm bone, which Hippocrates calls a joint,* 1.2 lies and stands against it; who is it that can but imagine 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, be∣sides also the back and acromion of the blade; and lastly, the anchor-like, or beak-like process, all which four hinder this joint from slipping inwards. Now Hiprocrates saith, that he hath only seen one kind of dislocation of this bone, to wit, that which is downwards, or to the arm-pit: and certainly it is the most usual and frequent; wherefore we intend to handle it in the first place. When the shoulder is dislocated downwards into the arm-pit,* 1.3 a depressed cavity may be perceived in the upper part of the joint; the acromion of the blade shews more sharp and standing forth than ordinary, for that the head of the shoulder bone is slipt down, and hid under the arm-pit, causing a swelling forth in that place; the elbow also casts it self (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 ear on that side, neither to his mouth, nor shoulder. Which sign is not peculiar to the luxated shoulder, but common to it, affected with a contusion, fracture, inflamation, wound, abscess, schirrus, or any defluxion upon the nerves, arising out of the vertebrae of the neck, and sent into the arm; also this arm is longer than the other. Lastly, (which also is common to each difference of a luxated shoulder) the Patient can move his arm by no kind of motion without sense of pain, by reason of the extended and pressed muscles, some also of their fibres being broken.* 1.4 There are six ways to restore the shoulder luxated downwards into the arm-pit: The first is, when it is performed with ones fist, or a towel; the second, with a clew of yarn, which put under the arm-pit, shall be thrust up with ones heel; the third, with ones shoulder put under the arm-hole; which manner, 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 chil∣dren eunuchs, and women; the fourth, with a ball put under the arm-pit, and then the arm cast over a piece of wood held upon two mens shoulders, or two standing posts; the fifth, with a lad∣der; the sixth, with an instrument called an Ambi. We will describe these six ways, and present them to your view.