Codman, Ann Surg 1931 - The Pathology Associated with Rupture of the Supraspinatus Tendon

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The Pathology Associated with Rupture of the Supraspinatus Tendon

Codman, Akerson·Ann Surg·1931·272 citations·Case series

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Codman and Akerson examine the shoulder pathology found at autopsy in aged, laboring patients. They ask whether supraspinatus rupture is primarily traumatic or the end-result of a degenerative process. The paper introduces rotator cuff disease to pathologists as a common, diagnosable, and treatable cause of shoulder disability.

Key Findings

Supraspinatus rupture was found in 39% of 100 shoulder joints taken from 52 consecutive autopsies of aged laboring patients. Codman argues this represents a maximum for this population and that younger general-hospital autopsies would show a lower rate.
Tears were more common on the right (46%) than the left (32%), which Codman reads as support for a traumatic contribution. He balances this against 14 bilateral cases and rarity in young men, which favor an underlying degenerative cause.
Glenohumeral cartilage erosion appeared in 24 cases, exclusively in shoulders with a torn supraspinatus, and was proportionate to tendon damage. This is an early description of what we now call cuff tear arthropathy.
The supraspinatus was nearly always the first tendon to go, with only 1 of 100 joints showing another tendon torn while the supraspinatus stayed intact. Tears in the other short rotators extended laterally from the supraspinatus defect.
A torn tendon never truly heals. Codman describes the sequence: transverse rupture, retraction into a triangle, a feeble fibrous smoothing of edges, absorption of the tendon stub, and recession of the tuberosity with fibrocartilage forming on the exposed bone.
Codman reports diagnosing supraspinatus rupture clinically with low error and suturing the tendon in more than 40 cases, establishing it as a recognizable and repairable clinical entity at a time when the general profession did not accept this.

Board PearlIn aged laborers, 39% of shoulders show supraspinatus rupture, and cartilage erosion tracks with tendon damage — the first description of degenerative cuff disease and cuff tear arthropathy.

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|

The Pathology Associated with Rupture of the Supraspinatus Tendon

Codman, Akerson·Ann Surg·1931·272 citations·Case series

|

Codman and Akerson examine the shoulder pathology found at autopsy in aged, laboring patients. They ask whether supraspinatus rupture is primarily traumatic or the end-result of a degenerative process. The paper introduces rotator cuff disease to pathologists as a common, diagnosable, and treatable cause of shoulder disability.

Key Findings

Supraspinatus rupture was found in 39% of 100 shoulder joints taken from 52 consecutive autopsies of aged laboring patients. Codman argues this represents a maximum for this population and that younger general-hospital autopsies would show a lower rate.
Tears were more common on the right (46%) than the left (32%), which Codman reads as support for a traumatic contribution. He balances this against 14 bilateral cases and rarity in young men, which favor an underlying degenerative cause.
Glenohumeral cartilage erosion appeared in 24 cases, exclusively in shoulders with a torn supraspinatus, and was proportionate to tendon damage. This is an early description of what we now call cuff tear arthropathy.
The supraspinatus was nearly always the first tendon to go, with only 1 of 100 joints showing another tendon torn while the supraspinatus stayed intact. Tears in the other short rotators extended laterally from the supraspinatus defect.
A torn tendon never truly heals. Codman describes the sequence: transverse rupture, retraction into a triangle, a feeble fibrous smoothing of edges, absorption of the tendon stub, and recession of the tuberosity with fibrocartilage forming on the exposed bone.
Codman reports diagnosing supraspinatus rupture clinically with low error and suturing the tendon in more than 40 cases, establishing it as a recognizable and repairable clinical entity at a time when the general profession did not accept this.

Board PearlIn aged laborers, 39% of shoulders show supraspinatus rupture, and cartilage erosion tracks with tendon damage — the first description of degenerative cuff disease and cuff tear arthropathy.

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