Codman, Am J Surg 1938 - Rupture of the Supraspinatus

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Rupture of the Supraspinatus

Codman·Am J Surg·1938·57 citations·Case series

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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.

Key Findings

Complete supraspinatus rupture is proposed as the leading cause of shoulder disability lasting beyond one year after injury. Codman argues these patients never fully recover good arm use unless operated upon, making prompt recognition the key clinical goal.
Codman lists 18 clinical criteria present within 24 hours of injury, including labor occupation, age over 40, loss of elevation power, negative x-ray, faulty scapulohumeral rhythm, and a palpable tender sulcus with soft crepitus as the tuberosity passes under the acromion.
The inability to hold the abducted arm at 90 degrees against slight downward pressure is described as the key test separating complete from incomplete rupture. This is an early form of the drop arm sign.
Mean age was 55 in complete cases versus 49 in partial cases, and below age 35-40 the tuberosity fractures before the tendon tears under forced elevation.
Complete ruptures never develop adhesions because joint fluid pumps in and out of the bursa. Partial ruptures instead frequently stiffen into frozen shoulder, so the two diverge over time.
Calcified deposits on x-ray are incompatible with complete rupture, helping distinguish it from calcific tendinitis and greater tuberosity fracture.
The supra- and infraspinatus retract outward together, not upward, so Codman revised his repair to suture the torn triangle starting at the outer angle rather than pulling the apex to the base.

Board PearlUnrecognized complete supraspinatus rupture is a leading cause of shoulder disability beyond one year — prompt diagnosis and early repair are essential.

Rupture of the Supraspinatus

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Rupture of the Supraspinatus

Codman·Am J Surg·1938·57 citations·Case series

|

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.

Key Findings

Complete supraspinatus rupture is proposed as the leading cause of shoulder disability lasting beyond one year after injury. Codman argues these patients never fully recover good arm use unless operated upon, making prompt recognition the key clinical goal.
Codman lists 18 clinical criteria present within 24 hours of injury, including labor occupation, age over 40, loss of elevation power, negative x-ray, faulty scapulohumeral rhythm, and a palpable tender sulcus with soft crepitus as the tuberosity passes under the acromion.
The inability to hold the abducted arm at 90 degrees against slight downward pressure is described as the key test separating complete from incomplete rupture. This is an early form of the drop arm sign.
Mean age was 55 in complete cases versus 49 in partial cases, and below age 35-40 the tuberosity fractures before the tendon tears under forced elevation.
Complete ruptures never develop adhesions because joint fluid pumps in and out of the bursa. Partial ruptures instead frequently stiffen into frozen shoulder, so the two diverge over time.
Calcified deposits on x-ray are incompatible with complete rupture, helping distinguish it from calcific tendinitis and greater tuberosity fracture.
The supra- and infraspinatus retract outward together, not upward, so Codman revised his repair to suture the torn triangle starting at the outer angle rather than pulling the apex to the base.

Board PearlUnrecognized complete supraspinatus rupture is a leading cause of shoulder disability beyond one year — prompt diagnosis and early repair are essential.

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