Incentive for this study was the discovery within a short period of time of two shoulders, each of which presented a large defect or groove in the posterolateral aspect of the head of the humerus (Figs. 3 and 4). The defect was variously interpreted by different consultants as due to infection, metastasis, and post-traumatic osteoporosis. A survey of the standard textbooks on roent-gen diagnosis and on orthopedics was of no assistance in differential diagnosis. Accordingly, a detailed study of the literature was made and 119 cases of dislocated shoulder, examined roentgenographically at the San Francisco Hospital between the years 1930 and 1940, were reviewed. This led to a clarification of our original conceptions regarding the nature of this lesion, and identified it not as a late result of dislocation of the shoulder, but as a true fracture. Review of the Literature Inasmuch as shoulder dislocations are the most frequent of all dislocations of the body, this subject has been of medical interest since ancient times. Hippocrates described the symptoms of dislocation of the shoulder and a method of reducing the luxation. Following Hippocrates, little was added to this subject until late in the nineteenth century when progress began to be made in the pathologico-anatomic changes occurring in shoulder dislocations. In 1861, Flower (8) reported upon 41 shoulder specimens which he had studied after collecting them from all of the pathologic museums of London. He described cases which showed rupture of the tendons inserted upon the greater tuberosity, fracture of the tuberosity, or the presence of a groove excavated on the articular head posterior to the greater tuberosity. Between 1880 and 1903, there were many case reports (Kuster, 1882; Cramer, 1882; Popke, 1882; Loebker, 1887; Schuller, 1890; Staffell, 1895; Francke, 1898; Wendel, 1903), which described the pathologico-anatomic findings in humeral heads resected for the relief of chronic or habitual dislocation (9). In all these cases there was such a similarity in the change found by the various operators that the groove or excavation became known as the “typical defect.” A composite description of these resected specimens may be summed up as follows: The defect is located posterior and medial to the greater tuberosity on the posterolateral aspect of the articulating surface of the humeral head. The groove is navicular or wedge-shaped and its average measurements are 2.5 cm. in length (cephalocau-dad), 1.5 em. in width, and 0.75 cm. in depth. The defect is demarcated from the surrounding normal bone by sharp or vertically projecting walls, which in the larger defects stand at a right-angle to each other. The spongiosa bordering the defect is thicker than elsewhere and is covered with a glossy, smooth connective tissue layer. No fragment avulsed from the humerus is to be seen (Fig. 1).
Copyright remains with the authors and publisher.
Incentive for this study was the discovery within a short period of time of two shoulders, each of which presented a large defect or groove in the posterolateral aspect of the head of the humerus (Figs. 3 and 4). The defect was variously interpreted by different consultants as due to infection, metastasis, and post-traumatic osteoporosis. A survey of the standard textbooks on roent-gen diagnosis and on orthopedics was of no assistance in differential diagnosis. Accordingly, a detailed study of the literature was made and 119 cases of dislocated shoulder, examined roentgenographically at the San Francisco Hospital between the years 1930 and 1940, were reviewed. This led to a clarification of our original conceptions regarding the nature of this lesion, and identified it not as a late result of dislocation of the shoulder, but as a true fracture. Review of the Literature Inasmuch as shoulder dislocations are the most frequent of all dislocations of the body, this subject has been of medical interest since ancient times. Hippocrates described the symptoms of dislocation of the shoulder and a method of reducing the luxation. Following Hippocrates, little was added to this subject until late in the nineteenth century when progress began to be made in the pathologico-anatomic changes occurring in shoulder dislocations. In 1861, Flower (8) reported upon 41 shoulder specimens which he had studied after collecting them from all of the pathologic museums of London. He described cases which showed rupture of the tendons inserted upon the greater tuberosity, fracture of the tuberosity, or the presence of a groove excavated on the articular head posterior to the greater tuberosity. Between 1880 and 1903, there were many case reports (Kuster, 1882; Cramer, 1882; Popke, 1882; Loebker, 1887; Schuller, 1890; Staffell, 1895; Francke, 1898; Wendel, 1903), which described the pathologico-anatomic findings in humeral heads resected for the relief of chronic or habitual dislocation (9). In all these cases there was such a similarity in the change found by the various operators that the groove or excavation became known as the “typical defect.” A composite description of these resected specimens may be summed up as follows: The defect is located posterior and medial to the greater tuberosity on the posterolateral aspect of the articulating surface of the humeral head. The groove is navicular or wedge-shaped and its average measurements are 2.5 cm. in length (cephalocau-dad), 1.5 em. in width, and 0.75 cm. in depth. The defect is demarcated from the surrounding normal bone by sharp or vertically projecting walls, which in the larger defects stand at a right-angle to each other. The spongiosa bordering the defect is thicker than elsewhere and is covered with a glossy, smooth connective tissue layer. No fragment avulsed from the humerus is to be seen (Fig. 1).
Copyright remains with the authors and publisher.