Patient lying on injured side; note arm hanging through hole in cot
raised from floor on chairs; also weight attached to wrist.]
The more ordinary method consists in putting the patient on his back
on the floor, the operator also sitting on the floor with his
stockinged foot against the patient's side under the armpit of the
injured shoulder and grasping the injured arm at the elbow, he pulls
the arm directly outward (i. e., with the arm at right angles with the
body) and away from the trunk. An assistant may at the same time aid
by lifting the head of the arm bone upward with his fingers in the
patient's armpit and his thumbs over the injured shoulder.
If the arm does not go into place easily by one of these methods it is
unwise to continue making further attempts. Also if the shoulder has
been dislocated several days, or if the patient is very muscular, it
will generally be necessary that a surgeon give ether in order to
reduce the dislocation. It is entirely possible for a skillful surgeon
to secure reduction of a dislocation of the shoulder several weeks
after its occurrence. After the dislocation has been relieved the arm,
above the elbow, should be bandaged to the side of the chest and the
hand of the injured side carried in a sling for ten days.
=DISLOCATION OF THE ELBOW.=--This is more frequent in children, and is
usually produced by a fall on the outstretched hand. The elbow is
thrown out of joint, so that the forearm is displaced backward on the
arm, in the more usual form of dislocation. The elbow joint is swollen
and generally held slightly bent, but cannot be moved to any extent
without great pain. The tip of the elbow projects at the back of the
joint more than usual, while at the front of the arm the distance
between the wrist and the bend of the elbow is less than that of the
sound arm. (See cut, p. 126.)
[Illustration: FIG. 31.
Above cut shows characteristic appearance of a dislocated shoulder;
note loss of fullness; also elbow held away from side and inward
sloping of arm.
FIG. 32.
DISLOCATED ELBOW AND SHOULDER.
(AMERICAN TEXT-BOOK.)
Fig. 32 shows dislocation of elbow backward; note swollen condition of
left elbow held slightly bent; also the projection of back of joint.]
For further proof that the elbow is out of joint we must compare the
relations of three points in each elbow. These are the two bony
prominences on each side of the joint (belonging to the bone of the
arm above the elbow) and the bony prominence that forms the tip of the
elbow which belongs to the bone of the forearm.
[Illustration: FIG. 33.
TREATMENT OF DISLOCATED ELBOW (SCUDDER).
Note padded right-angled tin splint; also three strips of surgeon's
plaster on arm and forearm.]
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