Human anatomy; Medicine -- Study and teaching; Palpation
=Tuberosities.=--Projecting beyond the acromion (the arm hanging
by the side), we can feel, through the fibres of the deltoid, the
upper part of the humerus. It distinctly moves under the hand when
the arm is rotated. It is not the head of the bone which is felt, but
the tuberosities, the greater externally, the lesser in front. These
tuberosities form the convexity of the shoulder. When the arm is
raised, this convexity disappears; there is a slight depression in its
place. The head of the bone can be felt by pressing the fingers high up
in the axilla.
The absence of this prominence formed by the upper part of the humerus
under the deltoid, and the presence of a prominence low in the hollow
of the axilla, or in front, below the coracoid process, or behind, on
the back of the scapula, bespeak dislocation of the head of the bone.
In examining obscure injuries about the shoulder, it is worth
remembering that, in the normal relation of the bones, and in every
position, the great tuberosity faces in the direction of the external
condyle. The head of the bone faces very much in the direction of the
internal condyle.
It is worth remembering also that the upper epiphysis of the humerus
includes the tuberosities; and that it does not unite by bone to the
shaft, till about the 20th year.
By making deep pressure in front of the shoulder, when the arm is
pendent and supine, we can feel the bicipital groove. It looks directly
forwards, and runs in a line drawn vertically downwards through the
middle of the biceps to its tendon at the elbow. We should be aware of
this, lest it be mistaken for a fracture.
132. =Coraco-acromial ligament.=--Under the anterior fibres of the
deltoid, we can distinctly feel the position and extent of the
coraco-acromial ligament. A knife, passed vertically through the middle
of it, goes at once into the shoulder joint and strikes the bicipital
groove with the tendon, a point to be remembered in excision.
In persons of an athletic build the triangular form and beautiful
structure of the deltoid become conspicuous when the muscle is in
action. The depression on the outer side of the arm, indicating its
insertion, is the place selected for issues or setons.
The arm being held up by an assistant, the anterior and posterior
borders of the relaxed deltoid admit of being raised so that in
amputation at the shoulder the knife can be introduced beneath the
muscle to make the flap.
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