ared
with that on the sound side, it is seen that, in addition to the lower
angle being more prominent, the spine is more horizontal and the lower
angle nearer the middle line. The majority of these cases recover if the
limb is placed at absolute rest, the elbow supported, and massage and
galvanism persevered with. If the paralysis persists, the sterno-costal
portion of the pectoralis major may be transplanted to the lower angle
of the scapula.

The long thoracic nerve may be cut across while clearing out the axilla
in operating for cancer of the breast. The displacement of the scapula
is not so marked as in the preceding type, and the patient is able to
perform pushing movements below the level of the shoulder. If the
reaction of degeneration develops, an operation may be performed, the
ends of the nerve being sutured, or the distal end grafted into the
posterior cord of the brachial plexus.

#The Axillary (Circumflex) Nerve.#--In the majority of cases in which
paralysis of the deltoid follows upon an injury of the shoulder, it is
due to a lesion of the fifth cervical nerve, as has already been
described in injuries of the brachial plexus. The axillary nerve itself
as it passes round the neck of the humerus is most liable to be injured
from the pressure of a crutch, or of the head of the humerus in
sub-glenoid dislocation, or in fracture of the neck of the scapula or of
the humerus. In miners, who work for long periods lying on the side, the
muscle may be paralysed by direct pressure on the terminal filaments of
the nerve, and the nerve may also be involved as a result of disease in
the sub-deltoid bursa.

The deltoid is wasted, and the acromion unduly prominent. In recent
cases paralysis of the muscle is easily detected. In cases of long
standing it is not so simple, because other muscles, the spinati, the
clavicular fibres of the pectoral and the serratus, take its place and
elevate the arm; there is always loss of sensation on the lateral aspect
of the shoulder. There is rarely any call for operative treatment, as
the paralysis is usually compensated for by other muscles.

When the _supra-scapular nerve_ is contused or stretched in injuries of
the shoulder, the spinati muscles are paralysed and wasted, the spine of
the scapula is unduly prominent, and there is impairment in the power of
abducting the arm and rotating it laterally.

The _musculo-cutaneous nerve_ is very rarely injured; when cut across,
there is