American Medical Association. Section On Orthopedic Surgery
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— Easily regulable method of automatically restoring abduction in the treat- ment of shoulder disability. Digitized by VjOOQLC SUBDELTOID BURSITIS 177 treatment in bed with automatic abduction, or the trouble subsides spontaneously, though slowly. There are some, however, that do not thus recover and some that, though they may eventually do so, meanwhile suflFer so much pain, loss of function and interference with occupation that operation is to be recommended as a means of prompt cure. I would... therefore advise operation in the following cases: '1. In the chronic form with exacerbations. These patients have been through all sorts of treatment for years ; their suffer- ings during the periods of exacerbation are severe; they show no tendency to spontaneous recovery. 2. In acute, "hyperacute" and chronic cases in which the automatic abduction in bed fails to restore function and to relieve pain and spasm. The operation I employ I have previously described.^® In consists in : splitting the deltoid ; raising the outer wall of the bursa from the inner and incising it; dividing all adhesions in the bursa; incising and retracting the floor of the bursa ; removing the deposit, if extratendinous, and suturing any tear in the supra- spinatus tendon; or incising the tendon wherever indicated by the roentgenogram and excising the deposits with surrounding tendon fibers, and reunit- ing the tendon with chromicized catgut (if the defect is not too large) ; suturing the floor of the bursa with a fine running catgut stitch ; anointing the interior of the bursa with a thin layer of petrolatum; suturing the outer wall of the bursa ; suturing in layers, without drainage, the deltoid muscle, the deltoid fascia and the skin; abducting the arm in plaster of Paris for about a week.
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