jury of the long thoracic nerve of Bell, or of the
fifth and sixth cervical nerve-roots through which they receive their
supply, the patient is unable to abduct the arm, and the deltoid
having lost its _point d'appui_, its contraction merely results in
tilting the angle of the scapula backward (Fig. 165).

[Illustration: FIG. 165.--Winged Scapula; the patient is holding the
arms out in front.]

_Treatment._--In the majority of recent cases the condition yields to
the administration of strychnin and other muscle and nerve tonics, and
the use of massage and the faradic current. The application of a
carefully adjusted padded belt is sometimes useful. The method of
treatment by stitching the latissimus dorsi over the lower angle of
the scapula is based on the erroneous assumption that the displacement
is due to the slipping of that muscle off the bone; at the same time,
it must be admitted that the operation sometimes diminishes the
deformity and adds to the patient's comfort.

A more efficient method consists in detaching the clavicular portion
of the pectoralis major from its insertion, and stitching it to the
serratus anterior so as to make it take on the function of this
muscle, or stitching it to the axillary border of the scapula. Success
has also followed suture of the vertebral border of the scapula to the
subjacent ribs (Eiselsberg).

_Displacement of the scapula upwards and laterally_ has been observed
as a result of partial paralysis of the trapezius when the nerves
supplying it have been divided in removing tuberculous glands from the
neck. In these acquired displacements, treatment is directed towards
the nerve lesion and towards the improvement of the muscles by
electricity, massage, and exercises; when the paralysis of the
trapezius is permanent, the disability is gradually overcome by the
compensatory hypertrophy of the levator muscle.

#Congenital Dislocation of the Shoulder.#--This rare condition is
usually bilateral, and is associated with other congenital defects.
The glenoid cavity is deformed or absent, and the dislocation may be
sub-coracoid, sub-acromial, or sub-spinous. The movements of the arm
are restricted, and the development of the extremity as a whole is
imperfect. It is sometimes possible to reduce the dislocation by
manipulation, or, if this fails, by operation. Unilateral dislocation
is sometimes mistaken for dislocation that has occurred during
delivery and _vice versa_.

#Habitual