SPECIAL INJURIES OF BONES. 3,15 



TUMOURS ON THE SHOULDER. 



Often preceded by chafing or galling, these consist of inflam- 

 mation and suppuration beneath the large flat muscle which 

 covers the front of the shoulder {levator humeri). The tissues 

 around the matter become thickened and indurated to an extra- 

 ordinary extent, so that it is often impossible to detect any 

 fluctuation, yet it may be assumed in all cases of considerable 

 swelling that matter really exists, and the recovery will not 

 ensue until that has been evacuated. In slight cases only will 

 a little nut-like induration form without matter. 



Treatment. — In cases in which injury has just been sustained, 

 suspend work or drive in a breast strap, and treat as for 

 chafing. If a tumour forms, first subdue the more active in- 

 flammation by a dose of physic and a wet rug slung over the 

 shoulder for several days ; then open it with a knife, or prefer- 

 ably, draw off the liquid once or twice, at intervals of two or 

 three days, with a cannula and trocar, and then, when the sac 

 has been reduced to a small size, lay it freely open with the 

 knife and treat like an ordinary wound. In very large tumours 

 it may be necessary to push the cannula in as far as four or 

 even six inches before the matter is reached, but the operator 

 must persevere, directing it always toward the exact centre oi 

 the swelling. The small solid tumours are to be cut out with 

 the knife, a straight vertical incision being made through the 

 skin, directly over the mass, which is then dissected out, and 

 tiie skin brought together with stitches and treated like a 

 simple wound. 



SPRAIN OF THE CORACORADIAL TENDON. SHOULDER SPRAIN. 



This is a sprain of the large tendon which passes over the 

 point of the shoulder (the most prominent part directly in front), 

 and in bad cases the double pulley over which it jilays in front 

 of the upper end of the arm bone is involved in inflammation 

 and ulceration. 



