sions of shoulder--FRACTURE OF
SCAPULA: Sites--FRACTURE OF UPPER END OF HUMERUS: _Surgical neck_;
_Separation of epiphysis_; _Fracture of head, anatomical neck, or
tuberosities_--FRACTURES OF SHAFT OF HUMERUS.

The injuries met with in the region of the shoulder include fractures
and dislocations of the clavicle, fractures of the scapula,
dislocations and sprains of the shoulder-joint, and fractures of the
upper end of the humerus.

#Surgical Anatomy.#--For the examination of an injury in the region of
the shoulder the patient should be seated on a low stool or chair.
After inspecting the parts from the front, the surgeon stands behind
the patient and systematically examines by palpation the shoulder
girdle and upper end of the humerus. The uninjured side should be
examined along with the other for purposes of comparison.

Immediately lateral to the supra-sternal notch, the sterno-clavicular
articulation may be felt, the large end of the clavicle projecting to
a varying degree beyond the margins of the small and shallow articular
surface on the sternum. Any dislocation of this joint is at once
recognised. The clavicle being subcutaneous throughout its whole
length, any irregularity in its outline can be easily detected. A
small tubercle (deltoid tubercle) which frequently exists near the
acromial end is liable to suggest the presence of a fracture. The
lateral end forms with the acromion the acromio-clavicular joint,
which, however, is not always readily identified. The fingers are now
carried over the acromion, which often exhibits in the situation of
its epiphysial cartilage a prominent ridge, which must not be mistaken
for a fracture. The tip of the acromion is usually employed as a fixed
point in measuring the length of the upper arm.

The outline of the spine of the scapula can be traced back to the
vertebral border; and the body of the bone may be manipulated, and its
movements tested by moving the arm.

The coracoid process can be recognised in the upper and lateral angle
of the triangular depression bounded by the pectoralis major, the
deltoid, and the clavicle.

The head and surgical neck of the humerus may now be felt from the
axilla, if the axillary fascia is relaxed by bringing the arm to the
side. The great tuberosity can be indistinctly felt on the lateral
aspect of the shoulder through the fibres of the deltoid. It lies
vertically above the lateral epicondyle, and may be felt to rotate