Codman addresses how to recognize and surgically treat complete rupture of the supraspinatus tendon. He frames the paper as advice to an industrial surgeon, arguing that this lesion is the most commonly missed cause of persistent shoulder disability after injury. He details clinical criteria, imaging, and repair technique.
When a laborer over 40 fails to recover shoulder function within a year of a fall, think complete supraspinatus rupture before labeling it bursitis, neurosis, or malingering. Codman's central teaching is that this lesion is frequently missed, and once the edges retract and scar, repair becomes technically difficult. Early diagnosis and repair give the best result.
His drop arm concept still holds: a patient who cannot hold the arm at 90 degrees against gravity likely has a complete tear. Preserved strength in that position argues for a partial tear. Remember the divergence over time. Complete tears stay mobile because bursal fluid prevents adhesions, while partial tears stiffen into frozen shoulder if the patient keeps working through pain.
For partial tears with an intact bursal base, gentle pendulum exercises to prevent atrophy and adhesions are preferred over immobilization or aggressive therapy.
Codman addresses how to recognize and surgically treat complete rupture of the supraspinatus tendon. He frames the paper as advice to an industrial surgeon, arguing that this lesion is the most commonly missed cause of persistent shoulder disability after injury. He details clinical criteria, imaging, and repair technique.
When a laborer over 40 fails to recover shoulder function within a year of a fall, think complete supraspinatus rupture before labeling it bursitis, neurosis, or malingering. Codman's central teaching is that this lesion is frequently missed, and once the edges retract and scar, repair becomes technically difficult. Early diagnosis and repair give the best result.
His drop arm concept still holds: a patient who cannot hold the arm at 90 degrees against gravity likely has a complete tear. Preserved strength in that position argues for a partial tear. Remember the divergence over time. Complete tears stay mobile because bursal fluid prevents adhesions, while partial tears stiffen into frozen shoulder if the patient keeps working through pain.
For partial tears with an intact bursal base, gentle pendulum exercises to prevent atrophy and adhesions are preferred over immobilization or aggressive therapy.