PARALYSIS OF THE SHOULDER; WITH ESPECIAL REFERENCE TO ITS MECHANICAL TREATMENT

1. The disability in paralysis of the shoulder, from any cause, is due not only to the paralysis itself but to overstretching of the weakened muscular tissue, the anatomical construction of the joint being such that it is poorly adapted for maintaining its intregrity in the presence of paralysis; the fact that the deltoid is the most likely of all the muscles of the arm to present permanent disability is to be ascribed solely to unfavorable mechanical conditions.

2. In so far as this disability is the result of overstretching, it may be overcome by the application of the principle of maximum relaxation of the affected muscles. Since impairment of supination at the wrist and flexion at the elbow are often associated with the disability at the shoulder, the position suggested for carrying out this principle is one of supination at the wrist, flexion at the elbow, and outward rotation, abduction and elevation of the arm at the shoulder, thus bringing the palm to rest on the top of the head; an additional advantage of this position is that it provides for maximum stretching of the unaffected adductors.

3. Since this method is a conservative one, its use is recommended in all cases not known to be completely paralyzed. While in some cases the paralysis is so extensive that the remaining power will be insufficient, even when developed to its highest degree of efficiency, to maintain contact between the head of the humerus and the glenoid and in others it may be sufficient to maintain contact but no more, yet there are still others with a greater degree of recovery of the nerve lesion in which a varying amount of active abduction will be secured. The use of the method is also recommended as a preliminary measure to muscle grafting.

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