The skin usually separates at the highest point and the muscles protrude, appearing to be tightly embraced and almost strangulated by the skin, and also by the tendons, vessels, and nerves which, crushed and twisted with the fragments of bone, form a conical stump.

Cheselden reports the history of a case, which has since become classic, that he observed in St.
Thomas' Hospital in London, in 1837.

A miller had carelessly thrown a slip-knot of rope about his wrist, which became caught in a revolving cog, drawing him from the ground and violently throwing his body against a beam.

The force exerted by the cog drawing on the rope was sufficient to avulse his whole arm and shoulder-blade.

There was comparatively little hemorrhage and the man was insensible to pain; being so dazed and surprised he really was unconscious of the nature of his injury until he saw his arm in the wheel.
According to Billroth the avulsion of an arm is usually followed by fatal shock.