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AN ANALYSIS OF TWENTY-EIGHT CONSECUTIVE CASES OF INCAPACITATING SHOULDER LESIONS, RADICALLY EXPLORED AND REPAIRED.

BOSWORTH, DAVID M.
The Journal of Bone & Joint Surgery: April 1940
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1. Thorough inspection of the shoulder joint and complete and satisfactory repair of any lesion demand wide exposure. The division of the deltoid fibers described leaves no permanent clinical defect.

2. Lacerations of the supraspinatus and the infraspinatus tendons show no gross or microscopie evidence of repair or of fibrosis, but they do show progressive degenerative changes with associated fibrotic lesions in the subacromial bursa and about the subscapularis tendon. Old cresentic lesions are the result of 'tear and wear' and not of 'wear and tear'.

3. Laceration of these tendons may be expected to cause progressive degeneration and increasing symptoms.

4. A new subacromial-bursa formation may occur after complete obliteration following sharp dissection, replacement of the mobile elements at their highest functional point, and gradual lowering after healing. There is apparently a drawing-out of new bursal lining from the portion of the bursa remaining under the acromion process.

5. Calcified shadows in the short-rotator tendons may actually be osseous in formation and, therefore, impossible of removal by conservative means.

6. Repair of complete avulsion of the short-rotator cuff is unsatisfactory, and primary shoulder fusion is indicated, especially when complete axillary-nerve lesion is present.

7. Moderate delay of operative interference in suspected acute ruptures does not prejudice the final outcome, and is justifiable.

8. Diagnosis of suspected short-rotator-tendon laceration has been exceptionally accurate, but the lesion itself may be hidden and its demonstration may require more complete exploration than simple bursal incision.

(C) 1940 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc.

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