Note on recurrent dislocation of the shoulder joint; superior approach causing the only failure in 52 operations for repair of the labrum and capsule.

Fascial sling operation-The single case of fascial slinging, performed many years ago by the Henderson technique, may be dismissed ; the operation is known to be unreliable and it has long since been abandoned. Transplantation of biceps tendon-The Nicola operation with its various modifications has also been abandoned for more than five years. In this particular series the failed cases were shown at secondary operation to have sustained rupture of the transplanted tendon. This is by no means true of all failures of tile Nicola transplant. The operation may fail for a number of reasons, and notably because the biceps tendon is often so placed that the humeral head can rotate around it and dislocate without so much as a strain being thrown upon the tendon. The explanation of the constancy of tendon rupture in this series possibly lies in the fact that the humerus was always drilled while it was held in the position of full internal rotation, and the direction of the drill hole was so planned that the tendon served as a check to external rotation movement which has long been recognised as the exciting cause of recurrent dislocation. Such check may explain the success of the operation in a proportion of patients, particularly those who are prepared to lead a sedentary life. But in this series of young athletic men it failed in one-third of the cases. \Vhatever the cause of failure, whether through misplacement of the tendon, or through rupture of the tendon because it is unequal to the task, the operation fails far too often. Repair of glenoid labrum with reefing of capsule--The particular purpose of this note is to record fifty-two operations in which the glenoid labrum was exposed. In fifl v-one