SECT. CXIII.—ON THE CLAVICLE AND ACROMION.
The clavicle, at its inner extremity, is not liable to dislocation, for there it is articulated with the sternum, where it admits of no motion. But if from any sudden and violent force from without, it should be torn from its place, it is to be subjected to the same treatment as a fracture. And its extremity which is articulated with the shoulder does not readily fall out of the joint, being prevented by the biceps muscle and the acromion. But neither does the clavicle admit any strong peculiar motion of its own, being made solely for the expansion of the thorax, and hence man is the only animal which has a clavicle. If it should sometimes happen to be dislocated in wrestling, it is to be replaced with the hand, assisted by the application of many-folded compresses, together with convenient bandages. When the acromion is sub-luxated it may be restored to its proper place by the same treatment. It is a small cartilaginous bone connecting the clavicle to the scapula, which is not to be seen in the skeletons. This, if moved a little from its place, exhibits the appearance to inexperienced persons of the head of the arm being dislocated; for the top of the shoulder appears sharper, and there is a hollow from which it was removed; but the cases are to be distinguished from one another by the symptoms about to be enumerated.
Commentary. The dislocation of the outer end of the clavicle from the acromion is treated of by Hippocrates, who gives a very distinct account of the symptoms and mode of treatment. He warns the surgeon not to confound this accident with dislocation of the humerus, as he had frequently seen done. He directs the surgeon to push down the projecting end of the bone; and then to secure it with compresses, and bind the arm to the side. He holds that the accident always leaves some deformity. (De Articulis, 15.)
Galen mentions that this accident happens most commonly to young persons, and that when not reduced it occasions a wasting of the arm. The account which Galen in this place and, copying from him, our author have given of the accident to which they represent the acromion as being subject, has been the subject of much controversy among modern authorities. See Cocchi (Chirurg. Vet. 133); and Littré (Hippoc. iv, 12.) Hippocrates, whom they both evidently had in view, (de Artic. 13), clearly refers to dislocation of the scapular end of the clavicle; and probably Galen alludes to the same, complicated with separation of the acromion from the scapula in young subjects. We would beg leave to quote what Monro says of the acromion: “This is an epiphyse in children; and in some old subjects I have seen it joined by a cartilage to the spine.” (Anat. of the Bones, p. 231.) Galen states decidedly that in young persons this process is sometimes bent along with the clavicle, and in them that replacement of the parts to their natural state is easily effected. He adds, “as dry wood is not adapted for bending, but such as is sappy and green bear this, in the same manner the bones of growing animals can be bent by force, and more especially such as are porous and fistulous, as the clavicle is.” Galen relates that in his own person he met with the accident while wrestling in the Palestra, and that by using oily fomentations and light bandages, a cure was at last effected. He says he was then thirty-five years old, but adds, that he had never known another person cured who was so far advanced in life. (Ibid. 134.) Avicenna gives the same account of the acromion as the Greeks. (iv, 5,1, 10.)
Neither Celsus nor Oribasius has treated of this case of dislocation.
Rhases, Avicenna, Haly Abbas, and Albucasis agree that dislocations occur more frequently at the acromial than at the sternal end of the clavicle. Desault and Boyer, on the other hand, affirm that the accident occurs oftener at the sternal extremity; but Sir Astley Cooper’s ample experience confirms the correctness of the ancient statement. Mr. Liston also agrees in stating that dislocation at the acromial end is much more frequent than at the sternal.