32 Anatomy Applied to Medicine and Surgery. 



Operations. Excision of the shoulder joint is done 

 through an incision starting from the beak of the cora- 

 coid process and running downwards and outwards to 

 avoid the cephalic vein which lies between the deltoid and 

 pectoralis major. The incision is parallel to the fibres of 

 the former muscle, is four inches in length and close to 

 the inner border of the muscle. The capsule and perios- 

 teum are next divided on the outer side of the biceps ten- 

 don. An assistant rotates the arm inwards and the sur- 

 geon detaches the periosteum, capsule and tendons from 

 the greater tuberosity. The biceps is raised out of its 

 groove, and, with the arm rotated outwards, the subsea- 

 pularis and the capsule are separated from the lesser tu- 

 berosity, and the head of the bone removed. 



Disarticulation at the Shoulder Joint. To avoid 

 haemorrhage in this operation, apply an elastic tourniquet 

 through the axilla, and clamp or tie it above the shoulder, 

 and then make a circular incision around the arm, a little 

 below the anterior border of the axilla. After retraction 

 of the skin, the soft parts are separated from the bone and 

 the axillary artery and vein ligated at the level of the 

 transverse line of section. A vertical incision is now made, 

 from the outer side of the coracoid process, down to the 

 lower incision, and the bone disarticulated. 



