addition to lining the
capsular ligament, is prolonged down the inter-tubercular (bicipital)
groove around the long tendon of the biceps, and pus may escape from
the joint by this diverticulum and gravitate down the arm; we have
also observed loose bodies of synovial origin in this diverticulum.
There is frequently a communication between the joint and the
sub-deltoid bursa. There is no attitude characteristic of disease of
the shoulder-joint, but the girdle is usually elevated, the upper arm
held close to the side and rotated medially, while the elbow is
carried a little backwards. In the later stages, the head of the
humerus may be drawn upwards and medially towards the coracoid
process. Fixation of the shoulder-joint is largely compensated for by
movement of the scapula on the thorax, so that when testing for
rigidity the scapula should be fixed with one hand while passive
movements of the arm are carried out with the other. The deltoid is
usually atrophied, allowing the acromion, coracoid, and great
tuberosity of the humerus to stand out prominently beneath the skin.
Swelling is rarely a prominent feature, except when there is a
collection of synovial fluid or of pus in the bursa beneath the
deltoid.

#Tuberculous Disease# is usually met with in young adults, and is more
common in the right shoulder. The prominent features are pain,
rigidity, and wasting of the deltoid and scapular muscles. The pain is
sometimes severe, shooting down the arm and interfering with sleep,
and it may be associated with tenderness on pressure over the upper
end of the humerus. In cases with carious destruction of the
articular surfaces there are starting pains, and the arm is shortened.
If a cold abscess forms in the bursa underneath the deltoid, the pus
may burrow and appear at the anterior or posterior boundary of the
axilla or in the axillary space. Pus formed in the joint tends to
gravitate along the inter-tubercular groove. The axillary glands may
be infected.

The primary lesion is either a caseating focus in one of the
bones--most often in the upper end of the humerus--or it is of the
nature of caries sicca. The greater part of the head may disappear,
and the upper end of the shaft be drawn against the socket. In
exceptional cases, portions of the glenoid or humerus are found
separated as sequestra, or the disease involves parts outside the
joint, such as the acromion or coracoid process. Hydrops with
melon-seed bodies is rare