performing this operation no rent in the capsule is
discovered.

The condition is also met with in epileptics; and it is generally
found that the head of the bone is deficient, as a result either of
fracture or disease; that the muscles which naturally support the
joint are atrophied or torn; and that the capsule is unduly lax.

#Sprain# of the shoulder-joint is comparatively rare, because of the
wide range of movement of which it is capable. The region of the
shoulder becomes swollen and tender to pressure, the point of maximum
tenderness being over the front of the joint, just below the acromion
process; pain is elicited also when the ligaments or tendons are put
upon the stretch.

#Contusion# of the region of the shoulder, on the other hand, is
exceedingly common. In most cases it is merely the deltoid muscle and
the subcutaneous tissue over it that are bruised, but sometimes a
haematoma forms either in the muscle or in the sub-deltoid bursa. There
is pain on moving the limb, and the patient may be unable to abduct
the arm at the shoulder-joint. Under treatment by massage and
movement, the symptoms usually pass off completely in two or three
weeks. The affections of the _bursa_ are described elsewhere.

In other cases, the cords of the brachial plexus above the clavicle
are stretched, or the axillary nerve is bruised, and these injuries
are liable to be followed by prolonged pain, loss of abduction, and
stiffness in the arm. The deltoid frequently undergoes considerable
atrophy, and there is severe neuralgic pain in the axillary nerve,
especially marked in the region of the insertion of the deltoid.

In addition to maintaining the limb in the abducted position, it is
necessary to keep up the nutrition of the muscles by massage and
electricity.

FRACTURE OF THE SCAPULA

Fractures of the scapula may implicate the body, the surgical neck,
the acromion, or the coracoid process. They are rarely compound.

#Fracture of the Body.#--Considering its exposed position, the body of
the scapula is comparatively seldom fractured, doubtless because of
its mobility, and the support it receives from the elastic ribs and
soft muscular cushions on which it lies. Apart from gun-shot injuries,
it is most frequently broken by a severe blow or crush. The scapula
presents two natural arches--one longitudinal, the other
transverse--and when the bone is crushed or struck, the force produces
fracture by undoing its curves (E. H. B