Alexandre.laedermann at 09:46, 12 July 2022

2022-07-12T09:46:43Z

Alexandre.laedermann: /* What would Codman have thought about this? */

2020-01-27T21:56:12Z

What would Codman have thought about this?

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Alexandre.laedermann at 21:40, 27 January 2020

2020-01-27T21:40:58Z

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Alexandre.laedermann: Created page with "What would Codman have thought about this? Calcified deposits in the supraspinatus tendon CHAPTER VI As far as I know, the first patient to be operated upon for this -condit..."

2020-01-27T21:28:45Z

Created page with "What would Codman have thought about this? Calcified deposits in the supraspinatus tendon CHAPTER VI As far as I know, the first patient to be operated upon for this -condit..."

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 THE PATHOLOGY OF THE SUBACROMIAL BURSA AND OF THE  SUPRASPINATUS TENDON
-I DO NOT propose to review in detail the pathology of such general conditions as tuberculosis and syphilis, which, of course, may occur in this region, but merely to attempt to describe such pathologic changes as I have myself seen at operation in about two hundred explorations of the bursa on living patients. I have kept no record of the number of times I have studied the bursa in the cadaver, but I am sure I have opened over five hundred subacromial bursae, perhaps a thousand. It is significant that most of the pathological changes which I have noted had not been previously described, at least, so far as this particular bursa is concerned; and, per contra, the conventional pathologic conditions, such as suppurative inflammation, "rheumatic changes," syphilis, tuberculosis, new growths, etc., have seldom been observed by me. In the shoulder these lesions are relatively rare. On the other hand, lesions peculiar to this region are so often present that I have observed some of them in probably one-third of all the bursae I have examined in the dead, and, of course, in nearly all of the living cases. Fortunately, within the last few years, I have had the privilege of studying a much more systematic series of observations made by Dr. I. B. Akerson of the pathologic staff of the Harvard Medical School and pathologist to the Long Island Hospital of the Institutions Department of the City of Boston. We have published together in the Annals of Surgery for January, 1931, an article on "The Pathology Associated with Rupture of the Supraspinatus Tendon." The following quotation is from this paper:
+I do not propose to review in detail the pathology of such general conditions as tuberculosis and syphilis, which, of course, may occur in this region, but merely to attempt to describe such pathologic changes as I have myself seen at operation in about two hundred explorations of the bursa on living patients. I have kept no record of the number of times I have studied the bursa in the cadaver, but I am sure I have opened over five hundred subacromial bursae, perhaps a thousand. It is significant that most of the pathological changes which I have noted had not been previously described, at least, so far as this particular bursa is concerned; and, per contra, the conventional pathologic conditions, such as suppurative inflammation, "rheumatic changes," syphilis, tuberculosis, new growths, etc., have seldom been observed by me. In the shoulder these lesions are relatively rare. On the other hand, lesions peculiar to this region are so often present that I have observed some of them in probably one-third of all the bursae I have examined in the dead, and, of course, in nearly all of the living cases. Fortunately, within the last few years, I have had the privilege of studying a much more systematic series of observations made by Dr. I. B. Akerson of the pathologic staff of the Harvard Medical School and pathologist to the Long Island Hospital of the Institutions Department of the City of Boston. We have published together in the Annals of Surgery for January, 1931, an article on "The Pathology Associated with Rupture of the Supraspinatus Tendon." The following quotation is from this paper:
 "The present study has been made from autopsy material obtained at a large municipal hospital for chronic conditions. The patients sent to this hospital are people who are aged and down-and-out, and owing to the chronic character of their diseases, cannot be cared for at the other Boston hospitals. Dr. Akerson has made a study from one hundred specimens taken from fifty-two consecutive autopsies, and the percentage of cases showing evidence that the supraspinatus tendon had been ruptured at some time during the lives of these patients is high—39%. It may, therefore, be taken as a maximum, and it may be expected that pathologists performing routine autopsies in general hospitals for acute diseases, where the ages average considerably younger, will find a decidedly smaller percentage. We have made no attempt to correlate the past histories of these patients as to trauma or occupation with the autopsy findings. It would have been hardly possible under the circumstances.
 "As a routine method of examination of these cases, we recommend the pathologist to employ the form of incision which we use in operations on the living. A cut is made on the anterior aspect of the shoulder joint from the acromio-clavicular articulation downward for about two inches. The fibers of the deltoid are separated and retracted and the roof of the bursa is incised between two pairs of forceps as one opens the peritoneum. When the lips of the wound are retracted, the surface of the floor of the bursa can be made to pass in review by rotating the humerus. The base of the normal bursa is smooth and spherical and almost as colorless as the cartilaginous surface of the head of the bone, though it lacks the bluish luster of cartilage. Most rents in the tendons of the short rotators usually appear in this base as communications directly into the joint and are readily visible. Occasionally the tendon is ruptured beneath the base of the bursa, which is left intact. In the ordinary autopsy it would take but a few minutes' extra time to examine both bursa. If lesions are found, the head of the bone with the insertions of the short rotators can be removed and studied. This was the method used by Dr. Akerson and his findings are good evidence that some sort of pathological process has been at work in the subacromial bursae of these patients during their lifetime. One must understand that these findings are those accumulated by each individual subject in many years. They are end-results, not acute lesions."

Shoulder:Rotator Cuff Pathology/Rotator Cuff Tendinopathy - Revision history

Alexandre.laedermann at 09:46, 12 July 2022

Alexandre.laedermann: /* What would Codman have thought about this? */

Alexandre.laedermann at 21:40, 27 January 2020

Alexandre.laedermann: Created page with "What would Codman have thought about this? Calcified deposits in the supraspinatus tendon CHAPTER VI As far as I know, the first patient to be operated upon for this -condit..."