. Manual of operative surgery. in wound. Apply dressings. Begin motion inabout ten days. Brickner (Am. J. Med. Sc, March, 1915) notes that contusions or tearsof the supra-spinatus tendon, even when the trauma is mild, are sometimesfollowed by single or multiple deposits of lime salts in the tendon or on itssurface. When such are present and cause disability their removal is operates for Codmans bursitis as follows: Open the bursa through anincision which splits the deltoid from the outer border of the acromion down-wards over the greater tuberosity, , towards the externa
. Manual of operative surgery. in wound. Apply dressings. Begin motion inabout ten days. Brickner (Am. J. Med. Sc, March, 1915) notes that contusions or tearsof the supra-spinatus tendon, even when the trauma is mild, are sometimesfollowed by single or multiple deposits of lime salts in the tendon or on itssurface. When such are present and cause disability their removal is operates for Codmans bursitis as follows: Open the bursa through anincision which splits the deltoid from the outer border of the acromion down-wards over the greater tuberosity, , towards the external condyle. Withretractors open the bursa. Divide all adhesive bands. Excise any papilloma-like masses. Explore the whole bursa rotating and putting traction on the armas may be necessary to facilitate palpation. Incise the floor of the bursa, inthe same line as the skin incision, over the greater tuberosity and supra-spinatus Bid of c7ai/icte^ Acromion ,- J^i^tiired supra-spincdizsNobili7ed segment Flapco?Uamin^. I .^T-Ioffy^ead Mceps Codmans sabre-cut incision Fig. 1361. insertion and dissect it up from the tendon. If any deposit, fluid or solid isfound, remove such. If the tendon shows any superficial injury or tear withinwhich is more of the solid or cheesy material clear such away and trim and suturethe rent in the tendon. If the X-ray has shown calcareous material in the ten-don, completely remove such through an axial split in the tendon and suturethe wound with catgut. Close the wound in the floor of the bursa with finecatgut stitches. Smear the inside of the bursa with vaseline but leave nosmall lumps of the lubricant. Suture the roof of the bursa. Close the Immobilize the arm in a position of abduction (120°) until healing hastaken place. Injury to the Supra-spinatus Tendon.—Codman has shown that the deltoidcan act ejficiently as an abductor only after the supra-spinatus has pulled thehead of the humerus firmly against the scapular portio
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