Special Injuries of Bones, Joints and Muscles. 41 7 



assumed in all cases of considerable swelling that matter 

 really exists, and the recovery wiU not ensue until that has 

 been evacuated. In slight cases only wiU a, little nut-Mke 

 induration form without matter. 



Treatment. In cases in which injury has just been sus- 

 tained, suspend work or drive in a breast strap, and treat 

 ns for chafing. If a tumor forms, first subdue the Inore 

 active inflammation by a dose of physic and a wet rug 

 slung over the shoulder for several days ; then open it with 

 a knife, or preferably, 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 smaU size, 

 lay it freely open with the knife and treat like an ordinary 

 wound. In very large tumors 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, direct- 

 ing it always toward the exact centre of the swelling. The 

 small solid tumors are to be cut out with the knife, a 

 straight vertical incision being made through the sMn, 

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

 the skin brought together with stitches and treated like 

 a simple wound. 



SPRAIN OF THE CORACO-BADIAL TENDON. SHOTILDER 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 

 plays in front of the upper end of the arm bone is involved 

 in inflammation and ulceration. 



Symptoms. Pendent head, dragging toe, swinging out- 

 ward of the foot when being advanced, shortness of the 

 step, and a tendency to stand with the toe only resting 

 on the ground and the Umb bent but not advanced.^ Swell- 

 ing of the point of the shoulder is sometimes, though rarely 

 seen, but pressure on this point with the thumbs vnU 

 detect tenderness, which is especially marked as compared 

 with that of the other shoulder. The pressure should be 



