Rotator Cuff Essays - Shoulder, Synovial Bursae, Free Essays

Rotator Cuff Essays - Shoulder, Synovial Bursae, Free Essays Rotator Cuff It is often difficult to tell where concepts actually begin. It is certainly not obvious who first used the term rotator or musculotendinous cuff. Credit for first describing ruptures of this structure is often given to J. G. Smith, who in 1834 described the occurrence of tendon ruptures after shoulder injury in the London Medical Gazette. (Smith, 1834) In 1924 Meyer published his attrition theory of cuff ruptures. (Meyer, 1924) In his 1934 classic monograph, Codman summarized his 25 years of observations on the musculotendinous cuff and its components and discussed ruptures of the supraspinatus tendon. (Codman, 1934b) Beginning 10 years after the publication of Codman's book and for the next 20 years, McLaughlin wrote on the etiology of cuff tears and their management. (McLaughlin, 1944, McLaughlin and Asherman, 1951) Oberholtzer first carried out arthrography in 1933 using air as the contrast medium. (Oberholtzer, 1933) Lindblom and Palmer (Lindblom and Palmer, 1939) used radio-opa que contrast and described partial-thickness, full-thickness, and massive tears of the cuff. Codman recommended early operative repair for complete cuff tears. He carried out what may have been the first cuff repair in 1909. (Codman, 1934b) Current views of cuff tear pathogenesis, diagnosis, and treatment are quite similar to those that he proposed over 50 years ago. Pettersson has provided an excellent summary of the early history of published observations on subacromial pathology. Because of its completeness, his account is quoted here. (Pettersson, 1942) As already mentioned, the tendon aponeurosis of the shoulder joint and the subacromial bursa are intimately connected with each other. An investigation on the pathological changes in one of these formations will necessarily concern the other one also. A historical review shows that there has been a good deal of confusion regarding the pathological and clinical observations on the two. The first to observe morbid processes in the subacromial bursa was Jarjavay, (Jarjavay, 1867) who on the basis of a few cases gave a general description of subacromial bursitis. His views were modified and elaborated by Heineke (Heineke, 1868) and Vogt. (Vogt, 1881) Duplay (Duplay, 1872) introduced the term periarthritis humeroscapularis to designate a disease picture characterized by stiffness and pain in the shoulder joint following a trauma. Duplay based his observations on cases of trauma to the shoulder joint and on other cases of stiffness in the shoulder following dislocation, which he had studied at autopsy. The pathological foundation for the disease was believed by Duplay to lie in the subacromial and subdeltoid bursa. He thought that the cause was probably destruction or fusion of the bursa. Duplay's views, which were supported by his followers, Tillaux (Tillaux, 1888) and Desch, (Desche, 1892) were hotly disputed. His opponents, Gosselin and his pupil Duronea (Duronea, 1873) and Desplats, (Desplats, 1878) Pingaud a nd Charvot, (Pinguad and Charvot, 1879) tried to prove that the periarthritis should be regarded as a rheumatic affection, neuritis, etc. In Germany, Colley (Colley, 1899) and Kuster (Kuster, 1882) were of practically the same opinion regarding periarthritis humeroscapularis as Duplay. Roentgenography soon began to contribute to the problem of humeroscapular periarthritis. It was not long before calcium shadows began to be observed in the soft parts between the acromion and the greater tuberosity. (Painter, 1907) The same finding was made by Stieda, (Stieda, 1908) who assumed that these calcium masses were situated in the wall and in the lumen of the subacromial bursa. These new findings were indiscriminately termed bursitis calcarea subacromialis or subdeltoidea. The term bursoliths was even used by Haudek (Haudek, 1911) and Holzknecht. (Holzknecht, 1911) Later, however, as the condition showed a strong resemblance to humeroscapular periarthritis, it became entirely identified with the latter. In America, Codman(Codman, 1984) made a very important contribution to the question when he drew attention to the important role played by changes in the supraspinatus in the clinical picture of subacromial bursitis. Codman was the first to point out that many cases of inability to abduct the arm are due to incomplete or complete ruptures of the supraspinatus tendon. With Codman's findings it was proved that humeroscapular periarthritis was not only a disease condition localized in the subacromial bursa, but that pathological changes also occurred in the tendon aponeurosis of the shoulder joint. This