ADOLESCENT DEPRESSION - 1008 Words

Adolescent depression is a disorder that affects teenagers. It leads to sadness, discouragement, and a loss of self-worth and interest in their usual activities. Everyone experiences some unhappiness, often as a result of a change, either in the form of a setback or a loss, or simply, as Freud said, Everyday misery. The painful feelings that accompany these events are usually appropriate and temporary, and can even present an opportunity for personal growth and improvement. However, when sadness persists and impairs daily life, it may be an indication of a depressive disorder it comes to no surprise to discover that adolescent depression is strongly linked to teen suicide. Adolescent suicide is now responsible for more deaths in†¦show more content†¦Even typical romantic experiences, such as flirting and dating, can be challenging for teens — and might contribute to symptoms of depression. Tertiary Prevention Be wary of movies and TV shows that feature idealized characters and situations. If your child routinely gauges himself or herself against an impossible ideal, feelings of disappointment or depression might follow. Repeated exposure to negative or violent content might also aggravate feelings of depression, perhaps by promoting a negative or fearful view of the world. To prevent complications associated with adolescent depression in the home; Do not keep alcohol in the home or keep it securely locked Lock all guns and keep ammunition separate Lock up all prescription medications On the flip side, some research suggests that reading during adolescence might have the opposite effect perhaps offering a buffer against depression. Nursing Intervention: (1) Educating patients about healthy coping skills, problem solving, conflict resolution, social and assertiveness skills, and relaxation techniques (2) Educating parents about realistic, age-appropriate expectations and nonjudgmental, noncritical patterns of communication (3) Supporting healthy behaviors, healthy psychological defenses, and healthy relationships. (4) Cognitive behavior therapy is effective for mild to moderate childhood depression. It entails reality- based challenges to pervasive, automatic, negative, distortedShow MoreRelatedAdolescent Depression1112 Words   |  5 PagesDepression is a disease that afflicts the human psyche in such a way that the afflicted tends to act and react abnormally toward others and themselves. Therefore it comes to no surprise to discover that adolescent depression is strongly linked to teen suicide. Adolescent suicide is now responsible for more deaths in youths aged 15 to 19 than cardiovascular disease or cancer (Blackman, 1995). Despite this increased suicide rate, depression in this age group is greatly underdiagnosed and leads to seriousRead MoreDepression And Its Effects On Adolescent Depression1290 Words   |  6 PagesDepression is an issue facing a large amount of people today. It has becoming increasingly known that a lot of depression begins to start in the adolescent years for many i ndividuals. The social work profession is critical in helping this adolescent depression not lead to further depression in adulthood. To understand adolescent depression and what is needed to help people suffering from it, we need to further understand the prevalence of adolescent depression, the effects it has on teens sociallyRead MoreEffectiveness Of Cognitive Bibliotherapy On Adolescents With Mild And Moderate Depression1900 Words   |  8 Pagestrying to figure out the effectiveness of cognitive bibliotherapy on adolescents with mild and moderate depression. The article stated that the objective of the study was to explore the benefits of an already supported treatment approach cognitive therapy but with adolescents with depression. The study had three goals; one, to investigate the efficacy of cognitive bibliotherapy with adolescents whom have mild-moderate depression. The second was to explore the relation of 3 variables; compliance, participationRead MoreThe Problem Of Adol escent Depression1631 Words   |  7 Pages Adolescent Depression Depression a word we’re familiar with especially when it comes to adults, we know adults get depress and we understand the reasons, with the high demands in life it’s not uncommon to get lost in the shuffle. Depression in adult is something we have known for many years, but what has surprised many of us is that adolescents also get depressed. I myself still don’t fully understand the reasons why or how this happens. I see it very often adolescent coming in to theRead MoreEffects Of Depression On Adolescents And Young Adults925 Words   |  4 Pagesclinical depression one may be suffering from. Clinical Depression is a mood disorder that is treatable. 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In addition, concurring to the previous research (Fear, et al., 2009) (Flynn Rudolph 2011), (Lewis, Colli shawRead MoreAdolescent Depression : A Qualitative Study1103 Words   |  5 Pagespersistent link for the article that was read this week: Looking back at adolescent depression: A qualitative study. The persistent link is http://search.proquest.com.library.capella.edu/docview/198689594?accountid=27965. The Doi was not provided in the article. As some of us may know, depression is reflected as a mental health condition that can lead individuals to attempt/commit suicide against their life. In addition, depression is a disorder that causes individual to feel despondent, and with noRead MoreDepression And Adolescent Depression956 Words   |  4 Pagesan estimated  3 million adolescents aged 12 to 17 in the United States had at least one major depressive episode in the past year† (â€Å"Major Depression Among Adolescence†). One of the leading mental health issue amongst teen in America is depression. Depression (major depressive disorder) is defined in the American Psychiatric Association as causing an overwhelming feeling of sadness and loss of interest in activity. One must understand the causes of depression, how depression affects the adolescenceRead MoreDepression in Adolescents1561 Words   |  7 PagesDepression in Adolescents Depression is a huge plague in the world. The American Psychiatric Association reports that depression occurs if at least 5 of the following symptoms occur for at least 2 weeks: depressed or sad mood, decreased interest in activities that once was enjoyable, weight gain or loss, psychomotor agitation or retardation, fatigue, misplaced guilt, a lack of concentration, or even recurrent thoughts of death. Approximately 121 million people are affected by some form of depressionRead MoreEffects Of Depression On Adolescents And Adolescents1687 Words   |  7 PagesAdolescent Depression Introduction Depression is an illness that affects adults as well as adolescents. Actually, depression affects a great percentage of adolescents, more than one may think. One in five (20%) adolescents are experiencing some form of depression within their lifespan (Schwarz, 2009). There are many different forms of depression. From a major shift in behavior, constant feeling of helplessness, to a major influence as to why one is not excelling in activities that they once loved

Analysis Of The Book The Best Love - 1299 Words

People say that they are â€Å"in love† or that that they think they have found â€Å"the one† all of the time. Those words have almost become so easy to use but unfortunately it seems like no one really knows the true meaning of them anymore. So what is love? What is true love? As said in The Notebook, â€Å"The best love is the kind that awakens the soul and makes us reach for more; that plants a fire in our hearts and brings peace to our minds.†- Noah Calhoun or in Dear John when John says, â€Å"and when her lips met mine, I knew that I could to be a hundred and visit every country in the world, but nothing would ever compare to the single moment when I first kissed the girl of my dreams and knew that my love would last forever† –John. Both of those quotes are so powerful and so passionate and both of the men saying them to be so in love with their girls. But was either of these situations true love? Most people would say yes and that is probabl y why both films went on to be two of the most famous and most favorable love films of our time. But other than their amazing story lines and heart throbbing love stories and slight differences, one thing that is so amazing is just how similar their stories really are. In the Notebook a man by the name of Duke reads a story to a lady who has Alzheimer’s and has lost most of her memory. The story is about an upper class seventeen year-old named Allie Hamilton who is spending her summer in Seabrook, South Carolina with her family. There is a localShow MoreRelatedAnalysis of a Walk to Remember1696 Words   |  7 PagesAnalysis of A Walk to Remember I. Author Introduction/ Writing Style: The author of A Walk to Remember is Nicholas Sparks. He was born on December 31,1965. According to Wikipedia he is an internationally best selling American author. He writes novels with themes that include Christianity, love, tragedy, and fate. 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Information Technology Infrastructure Library - Free samples

Question: Discuss About the Information Technology Infrastructure Library? Answer: Introduction The development of technology had been largely developed and formed for forming the use of smart development of the operations. The ITIL or Information Technology Infrastructure Library is a collective development functions for forming the development of smooth operations in the organization (Lema et al. 2015). The Celanese Company requires the formation of the development factor for the development of the system integration. It is important for forming the accurate and appropriate development of the operations that would serve the factor of growth for the organization. Samanage works explicitly for the development of the tools and system development for the IT operations by providing the support to the operations of the organization. The following report would provide the analysis of the factors that led to the selection of Samanage software for the ITIL deployment in Celanese and the method used for the selection. The benefits and system advisor for the deployment would be evaluate d for the development of the operations of the organization. Overview of Celanese Organization and Samanage Software The Celanese Organization had been using the technology for the development of their operations in chemical industry. The organization is one of the largest producers of the chemical acetyl products and engineered polymers (Celanese.com. 2017). They had been using the polymers for manufacturing the conveyor belts, fuel system, and seat belt mechanism. The company had been using IT for developing their overseas expedition and sales process. They had formed the specific and smart development of their operations and increase of their overall sales in the organization. The PC standardization and the system development had been largely induced for providing the support to the development factors of the organizational operations. The Samanage Software had been deployed for the development of the effective and smart operations in the organization. The software works as an ITIL service desk for providing the faster and scaled up growth of the organization (Samanage.com 2017). The development of the organization would be responsible for forming the operational activities of the IT activities. The ITIL configuration had been deployed for forming the effective and smart development factors for the operational activities (in form of methods required and processes developed). The software would be implied for decreasing the time consumed for performing any operation. Analysis on the ITSM tool Recommended ITSM tool For Celanese CIO, the ITSM software Samanage is chosen. At the Samanage, the empowering of the services disk irrespective of size, whether big or small is done. This helps in igniting the excellence of the service. They have been further enhancing the expectations from the service qualities. They have been acquiring agile, scalable and the automated solutions for service management. These have been ranging from the managing of tickets to the service requests (Thompson, Hattingh and Buitendag 2014). All the resources, escalations along with the approvals needed in between are also considered here. The solution has been possessing clear interfaces. This has been appearing very straightforward. Thus, is has been easy for using. Here, the workflows could be created by simply making use of the drag and drop. The solution has been offering a helpful property by asking for help on tickets across the Information Technology (Wang and Qingfan 2013). This has been done without needing any escalation. For instance, the efficient practical usage to scan tickets includes the Eye function. This permits the scanning of details and without the necessity to open the ticket. Criteria for using the ITIL tool The huge scope of the services of Information Technology as delivered by the companies has been most succinctly represented by the ITIL or the Information Technology Infrastructure Library. To select Samanage, for Celanese, some criteria are taken into consideration. Beginning with the maturity assessment of ITSM: The Celanese might have a genuinely smart thought of what sort of abilities they expected form their ITSM programming to give. They have needed incredible IT benefit work area capacities (Ghosal et al. 2014). This ought to be including the cutting edge IT self-benefit inventory, an extensive CMDB, vigorous IT ticketing and the issue tracking along with contract and SLA administration. Determining the primary integrations of Samanage: Once the development appraisal is led, cleanses ought to pick up a comprehension. This should be regarding how the Samanage would fit into their more extensive arrangement of management tools of IT operations. The greater part of Celanese have different best-of-breed IT administration tools that has been domain-specific. The Samanage has been something that has been covered by every domain in some limit. Hence the understanding reconciliation capacities at the cutting edge of the purchasing cycle have been crucial. Assessing the value of Samanage vendors as the Business Partner: While it might appear to be fairly buzzword, Celanese could not downplay the significance of this point. Celanese has not been simply picking Samanage as an ITSM tool. Further, they have been picking an accomplice to work with (Bell et al. 2016). This has to be ideally over a time of numerous years. Of key significance has been ensuring Celanese that have confidence that the Samanage vendors would follow the commitments done by them. In order to receive suggestions regarding ITIL tool, the analyst expert of the ITSM Industry could be asked. It has been shrewd for Celanese to take an interest in the demos, converse with vendor references, reading item surveys and talk with the peers about what ITSM tool they have been using. Their experiences are also needed to be considered Tool features: The tool features include the native applications of cloud with every client over the latest version. The implementation has been concentrated over the lagging of consultancy and training needs. This has been based over intuitive product utilizing videos and the other Medias. The vendors have been selling and overcoming against the conventional ITSM products. This has been over abilities, easy usage and easy implementation along with ability on the non-IT implementation (Willfr 2016). The ITIL service lifecycle: The ITIL v3 Improvement has been used as the service cycle here. It would help Celanese address the challenges regarding business projects with the service life-cycle approach. Selection of the Samanage for business esteem of Celanese has been one of the key issues tackled with this lifecycle approach. Each association has been conveying as well as backing the services and products. . In this way, they have the routine with regards to service management. Administrations have the beginnings, the changes, and the endings. In other words it possesses the complete lifecycle. Understanding of the total lifecycle chain would help Celanese turn out to be more productive and compelling in overseeing administrations for esteem (Nabais et al. 2014). Celanese must utilize the ITIL processes from the accompanying points of view: Operational productivity as it was: Solving the operational issues without knowing the direct business esteem Enhance incident management Adopt all ITIL procedures or particular ones IT procedure for the operational proficiency: Solving business issues by tending to supporting administration abilities and assets. This has been incorporating process, individuals, innovation, and so forth Better orientation of service. Complete lifecycle point of view of the service value chain. Better administration of aggregate cost of proprietorship and rate of profitability Compliance of Samanage: There has been no such thing as the ITIL complaint for Samanage. Since it has been only about guidance, it has not been complaint to anything. Adoption of lots of methods in the workplace of Celanese never indicates that they have been complying. This has been especially while they have been utilizing some ideologies working in favor of them (Chen 2013). This is the purpose of Samanage. It is the best practice though it guides and help in using proper methods improving IT services. Tools handle ticketing: Once distinguished as the incident, the logs of service desk the incidents as the ticket. The ticket ought to incorporate data, for example, the client's name and contact data. It should also include the incident depiction, and date and time of incident report for SLA adherence. The logging procedure could likewise incorporate order, prioritization, and the means the area finished by service desks. The ITIL phase it works on as the software of incident management makes the parent-kid relationship. This is to act about as an extension between incident and the issue tickets. In ITSM, the parent-child relationship assumes a crucial part when any emergency or disappointment emerges (Shahsavarani and Ji 2014). This has been influencing numerous clients with a typical cause. By and by, the reported incident gets doled out as the parent and others identified with it as the children tickets. Recommended service desk model: The Help Desk Software of Samange could be utilized by Celanese. It has been born and brought up in environment of cloud. It has been developed keeping the optimum usability within the mind. This would help in simplifying and automating requests of services from the employees of Celanese. It would decrease the support workload. It would deliver enhanced service throughout Celanese along with increasing productivity. The service level agreement: Scope Factors to be included in SLA Description of Service Service or the services included in the opportunities of SLA Location of Service The physical position of the hardware or the software. Service Hours Time and days when the Customer can expect the service. Service Availability The target availability levels promised to be delivered. Service Capacity This includes the traffic volumes during the peak periods, number of transactions each period and the file server usage. Service Monitoring and Events Monitoring to be performed; handling of events and alerts, including notification paths and evaluation methods should be described. Incidents and the Service Requests Handling of the notifications of service interruption notifications. This also includes the updates of resolution status updates (O'Connor et al. 2015). Change Management The mechanism regarding Customer to request service functionality and the other changes in this service. Contact Information The information about the customer and IT. Glossary of Terms Terminology critical for the SLA. References References for additional information. Approvals Approving parties regarding Service Provider and Customer. Maturity ratings: The maturity ratings could be performed by going through the following questionnaires: How could the potential cultural risks be highlighted for the initiative of implementing Samanage? What are the positive parameters of cultures to get highlighted for supporting the initiative? Self-assessment: A purposeful information flow culture is an enabler to process change discussion of ratings. Assessment sponsor and supporting staff: Comprehending the procedure evaluation that has been coming about. Comprehending the ramifications of procedure evaluation that comes about (Iden and Eikebrokk 2015). Agreeing with the procedure evaluation has come about with enough status quo. Appraisal support and supporting staff: Comprehending the ITSM that has comes about. Comprehending the ramifications of outcomes of ITSM assessment. making sense that the assessment of Samanage has come about sufficiently representing existing conditions Strengths: Improvement in efficiency and reduction in the operational costs: The unnecessary rework and manual effort could be removed by the alerting, automation, workflow and the optimized processes. As the self-help and the self-service abilities used by the staffs, these are added. Workload reductions and the efficiencies of self-services: As the employees opt for going to self-help, they would achieve various resolutions. The log the requests and logs through the self-service for the staffs indicates lesser telephone calls to the equivalent of business function and the services desks. Limitations: There has been nobody among the appraisal support or staff. They have been needed to be grounded enough in ITIL. This has been to comprehend the ramifications of the procedure that the evaluation has come about. There has been nobody among the appraisal support or staff ready to address the issues declared in the way of ITSM proposals (Cots, Casadess and Marimon 2014). Recommendations: Administration has been required investigating group building openings inside their groups and with different groups Management ought to 'walk the discussions' and has been viewed to be working together over the departments (Mahy, Ouzzif and Bouragba 2016). For instance they have joint introductions for promoting the procedure activity Reviewing correspondence channels inside and crosswise over groups. The way improve them is required to be considered. Alignment of Samanage Software (IT) for the Operations of Celanese The Samanage Software is the most incredible factor that would serve the purpose of the development for the operations of the organization (Samanage.com 2017). There are certain factors that deploy the use of the system integrated operations for the organization. The deployment of the Samanage Software would have a considerable effect on the culture and processes of the Celanase Organization. The following sections would highlight the processes of the Samanage in the organization of Celanase. Merit of IT Implementation in Celanese The implementation of ITIL for Celanese would help in developing the proper operations for the organization and increase of the development factors for the implementation of the functions. The importance of implementing ITIL for Celanese is, Integration of all operations: The use of ITIL would allow the users of IT system in Celanese to develop the smooth operations of the organization (Iden and Eikebrokk 2015). The operations would be helpful for forming the integrated operations. The operations would form the accumulation of the compact development model that invokes the inclusion of the methods, steps, and system integration of the organization. Scope of development: The scope of development could be improved by the development of the functions (Ahmad and Shamsudin 2013). The improved operations would allow the development of the functions in the organization. The development factors would allow them for forming the increment of the organization. The scope of operations would allow the users for forming the development of the increased modification of the organization. Improvement of functions: The integrated operations would allow the users for developing the smart and improved functions of organization (Assad and Ahmad 2015). The development factor would form the chance for developing the factors of the development model. There are certain factors that would initiate the scope for developing the functions of Celanese Company. Discussion of IT culture and compatibility with ITIL The development of the IT culture in Celanese organization had been developed for increasing the scope of the development factors (Eikebrokk and Iden 2017). There are certain options that would deploy the development of the acute information processing for the organization. The IT culture integration of Celanese would be based on the development of the operations and formation of the effective and smart development for the organizational operations. The impact of ITIL implementation on the culture of Celanese is, Global operations resulting in influence of mixed culture of operations Working environment more impactful and developed Option for developing faster and more scalable communication within the organization Reluctance of business involvement or buy-in The Samanage would serve the purpose of ITIL implementation for the organization development. It would provide the base for the implementation of the system integration (Ahmad et al. 2013). The major aspects of the development model would allow the users for the formation of the integrated operations. However, some flaws of the ITIL implementation in Celanese are provided below, Technology dependency could result in major mishap due to any design flaw or technical issue Security issue in the system would also serve the purpose of the causing mayhem in the IT operations of the organization Integration issue would also serve the purpose of flaw in the operational processes Relevant process to avoid a situation: There are possibilities that the implementation of the Samanage would have to face any technical issue in Celanese. The problem of implementation in Celanese can be managed by the use of the Risk Management and use of Software development model (Al Mourad and Johari 2014). The software development in the organization can be done by following the mentioned steps, Step 1: Analysis of the issue faced Step 2: Planning for the development strategies Step 3: Implementing the system improvement Step 4: Reviewing/Monitoring the implemented system Step 5: Modifying the flaws for getting required results Recommendations Some recommendations for the Celanese are given below, Formation of integrated operations: The implementation of the ITIL in Celanese would be helpful for developing the system integration in the organization. The development of the operations would allow the users for forming the integration of the system functions. The integrated operations would help in forming faster and more effective information processing for the organization. There are several factors that have deployed for developing peculiar development of operations in the organization. The deployment of effective information processing would result in forming accurate development model for the organization. There are certain development criteria that had been developed for supporting the operations of the organization. System Development Life Cycle: The use of System Development Life Cycle would allow the users for forming the effective and smart development model in the organization. It would minimize the probability of the occurrence of the errors and flaws. The development of the system development life cycle would allow the users for forming accurate operational development models for the organization. The system development life cycle would help the users for developing the effective processing of the organization and formation of advanced system development. The system development life cycle would help in forming appropriate development of the organization and operations. The system development life cycle for improving their functions and operations. Conclusion It can be concluded from the report that the analysis of the factors that led to the selection of Samanage software for the ITIL deployment in Celanese and the method used for the selection had been helpful for integrating the operations of the organization. The organization selected is Celanese Organization that had been using the IT technology for the development of their operations in chemical industry. The ITIL software used for implementation is Samanage Software that had been deployed for the development of the effective and smart operations in the organization. The importance of implementing ITIL for Celanese is integration of all operations, scope of development, and improvement of functions. The impact of ITIL implementation on the culture of Celanese is global operations, working environment, and option for developing faster and more scalable communication. However, some flaws of the ITIL implementation in Celanese are technology dependency, security issue, and integration issue References Ahmad, N. and Shamsudin, Z.M., 2013. Systematic approach to successful implementation of ITIL.Procedia Computer Science,17, pp.237-244. Ahmad, N., Tarek Amer, N., Qutaifan, F. and Alhilali, A., 2013. Technology adoption model and a road map to successful implementation of ITIL.Journal of Enterprise Information Management,26(5), pp.553-576. Al Mourad, M.B. and Johari, R., 2014. Resolution of challenges that are facing organizations before ITIL implementation.International Journal of Future Computer and Communication,3(3), p.210. Assad, M.I. and Ahmad, M.A., 2015. Guidelines for ITIL Implementation: A Framework for IT Service Management. Bell, J.R., Heiser, M.F., Hinton, H.M., Readshaw, N.I. and Sivakumar, K., International Business Machines Corporation, 2016.Managing software deployment. U.S. Patent 9,319,430. Celanese.com. (2017). [online] Available at: https://www.celanese.com/foundation [Accessed 15 May 2017]. Chen, M., 2013. Service Management. Cots, S., Casadess, M. and Marimon, F., 2014, September. Benefits of implementing Service Management Standard ISO 20000. InProceedings of the 1st International Conference on Quality Engineering and Management(p. 3). Eikebrokk, T.R. and Iden, J., 2017. Strategising IT service management through ITIL implementation: model and empirical test.Total Quality Management Business Excellence,28(3-4), pp.238-265. Ghosal, S., Ghosh, A.K., Kambhatla, N., Kanjirathinkal, R.C., Lahiri, A., Majumdar, D., Mohamed, S.I. and Visweswariah, K., International Business Machines Corporation, 2014.Computer-implemented information reuse. U.S. Patent 8,768,921. Iden, J. and Eikebrokk, T.R., 2015. The impact of senior management involvement, organisational commitment and group efficacy on ITIL implementation benefits.Information Systems and e-Business Management,13(3), pp.527-552. Iden, J. and Eikebrokk, T.R., 2015. The impact of senior management involvement, organisational commitment and group efficacy on ITIL implementation benefits.Information Systems and e-Business Management,13(3), pp.527-552. Lema, L., Calvo?Manzano, J.A., Colomo?Palacios, R. and Arcilla, M., 2015. ITIL in small to medium?sized enterprises software companies: towards an implementation sequence.Journal of Software: Evolution and Process,27(8), pp.528-538. Mahy, Y., Ouzzif, M. and Bouragba, K., 2016, November. Supporting ITIL processes implementation using business process management systems. InSystems of Collaboration (SysCo), International Conference on(pp. 1-4). IEEE. Nabais, J., Pinto, A.M., Cruz, A. and Cardoso, J., 2014, June. Interface design for IT service management practice. InInformation Systems and Technologies (CISTI), 2014 9th Iberian Conference on(pp. 1-7). IEEE. O'Connor, R.V., Raisinghani, M., Mora, M., Gomez, J.M. and Gelman, O., 2015. An Extensive Review of IT Service Design in Seven International ITSM Processes Frameworks: Part II.International Journal of Information Technologies and Systems Approach,8(1), pp.69-90. Samanage.com (2017).ITSM Software, IT Asset Management, Help Desk Software | Samanage. [online] Available at: https://www.samanage.com/ [Accessed 15 May 2017]. Shahsavarani, N. and Ji, S., 2014. Research in Information Technology Service Management (ITSM)(20002010): An Overview.International Journal of Information Systems in the Service Sector (IJISSS),6(4), pp.73-91. Thompson, W., Hattingh, F. and Buitendag, A., 2014, May. Presenting a framework utilising the cloud to facilitate asset management. InIST-Africa Conference Proceedings, 2014(pp. 1-12). IEEE. Wang, T. and Qingfan, G., 2013, October. Research on distributed integrated modular avionics system architecture design and implementation. InDigital Avionics Systems Conference (DASC), 2013 IEEE/AIAA 32nd(pp. 1-53). IEEE. Willfr, J., 2016. 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Rotator Cuff Essays - Anatomy, Dance Science, Soft Tissue, Shoulder

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 and 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 wi th 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