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CASUS ILLUSTRATING TEE TREATMENT. 145
was so great that he turned quite faint, and could not rise without
assistance. On examination of the shoulder, the head of the
humerus was found lying under the clavicle. The swelling from
exudation was considerable, and extended over the whole of the
upper arm, on the inner side of which discoloration began to show
itself.
On the 22 nd, in the morning, the patient was put under chloro-
form, and the humerus replaced by circumduction. The arm was
afterwards put in an ordinary sling.
Feb. 23rfZ. I began with passive movements—viz. petrissage,
effleurage, rolling (fig. 5 0). Unnecessary movement at the shoulder
during the petrissage and effleurage was prevented by stretch-
ins: and adducting the arm to the side with one hand, while I
worked with the other.
Feb. 2Uh. No treatment.
Feb. 26th. The arm during the rolling could be carried as high
up as the level of the shoulder. There was great discoloration on
the inner side of the upper arm. On the previous day the patient
tried to move the arm himself, and had got it partly dislocated
again, the head of the humerus being on the anterior and lower
edge of the glenoid cavity. In order to prevent a recurrence of
this, the arm was bandaged up over the chest. Began with active
movements.
March 1st. He could stretch the arm horizontally forwards,
and if he steadied the hand against the wall of the room he could
work it up until it reached nearly as high as the sound one. The
rolling, extension, and flexion go much freer. When he half lies
with the back steadied, I could without difficulty stretch his arm
straight up. He could place his hand on his neck.
March Qth. The arm was left free, and he was told to
move it about often during the day. He can reach as high
up with the hand of the injured arm as with that of the sound
one.
March *Jth. The active movements under resistance show that
the muscles round the affected shoulder have almost completely
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