By E. Amory Codman
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Additional resources for The Shoulder Rupture of the Supraspinatus Tendon and Other Lesions In or About the Subacromial Bursa
It is obvious that if the surfaces of the bursa between the points A and B in a were adherent, it would be impossible for the joint to pass into the position shown in b. Note for the reader who likes puzzles. Notice in Fig. b the changes that the axes of the letters A and B have undergone in relation to the bottom of the page. Each letter has rotated twice. The letter A has rotated upward 45° by elevation of the clavicle, but since the clavicle has rotated backward, the artist has had to rotate the vertical axis of the letter in order to make it legible.
FIGURE 16. RANGE OF MOVEMENT OF BURSA The base and roof of the subacromial bursa are somewhat larger than any two circles depicted in this figure, which expresses diagrammatically the extent of motion of the bursa in varying positions of the joint. To understand this diagram (a) one must visualize the circle labeled "roof" as firmly fixed to the under side of the acromion and the acromio-clavicular ligament, while the circle labeled "base" is firmly fixed to the top and anterior aspect of the tuberosities and to the adjacent half inch of the tendons of the short rotators; an area, in fact, about as large as a silver half dollar.
In man such movement is easily performed, but in quadrupeds it is possible to a limited degree only, and is to be regarded usually as an indication of disease. " The horse clearly flexes his scapulo-humeral joint as he takes a jump and extends it as he lands on the other side. From a quadruped point of view we might say that the anatomic position of man is one of flexion of the shoulder; complete elevation of the arm (the Statue of Liberty or the diving position) is extension. FIGURE 20. ELEVATION OF THE ARM The term "elevation" clearly applies to the Statue of Liberty, but the arms seem to be "depressed" in the case of the diver, and it would seem absurd to use it to describe the position of these joints in the case of the horse, yet the relations in his shoulder bones are the same as in those of his human companions.