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The influence of cuff pathology on shoulder function after arthroscopic subacromial decompression: A 3- and 6-year follow-up study
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi. Linköpings universitet, Hälsouniversitetet.
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi. Linköpings universitet, Hälsouniversitetet.
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi. Linköpings universitet, Hälsouniversitetet.
1999 (engelsk)Inngår i: Journal of shoulder and elbow surgery, ISSN 1058-2746, E-ISSN 1532-6500, Vol. 8, nr 6, s. 585-589Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

In the literature operative management of rotator cuff ruptures in the shoulder varies, from tendon repair to debridement of the cuff lesion combined with subacromial decompression. This study was made to evaluate whether patients with intact rotator cuff differed from patients with rotator cuff ruptures regarding functional outcome after arthroscopic subacromial decompression. We performed a clinical review of 39 patients with subacromial impingement who all underwent arthroscopic subacromial decompression; no other surgery was performed. There were 13 patients with intact cuff, 13 patients with partial-thickness supraspinatus ruptures, and 13 patients with full-thickness supraspinatus ruptures <2 cm. Selection was based solely on the status of the supraspinatus tendon. Patients with other pathologic conditions were excluded. Follow-up was performed after 3 and 6 years. The clinical evaluation was performed with the Constant score and the visual analog pain score. The 3- and 6-year follow-up (100% follow-up rate) revealed no significant difference between the groups regarding the Constant scores and the visual analog scale values. Also, no significant difference was seen among the 3 groups in active range of motion or strength, and the patients had no appreciable pain. We conclude that the functional outcome 6 years after arthroscopic subacromial decompression is not obviously related to the preoperative degree of cuff pathology, even if a total rupture of small size is present.

sted, utgiver, år, opplag, sider
1999. Vol. 8, nr 6, s. 585-589
HSV kategori
Identifikatorer
URN: urn:nbn:se:liu:diva-49917DOI: 10.1016/S1058-2746(99)90094-0OAI: oai:DiVA.org:liu-49917DiVA, id: diva2:270813
Tilgjengelig fra: 2009-10-11 Laget: 2009-10-11 Sist oppdatert: 2017-12-12bibliografisk kontrollert
Inngår i avhandling
1. Subacromial inflammation: Clinical and experimental studies
Åpne denne publikasjonen i ny fane eller vindu >>Subacromial inflammation: Clinical and experimental studies
2001 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

Shoulder pain and disability are common clinical problems. One major cause is subacromial inflammation and impingement of the supraspinatus tendon. These patients are usually offered conservative treatment or arthroscopic subacromial decompression (ASD). However, in some patients pain and a deficient shoulder function persist in spite of conservative and surgical treatment. This reflects the fact that the pathophysiology of this important disease is not fully understood. The general aim of the present thesis was to generate new lmowledge contributing to the understanding of subacromial inflammation through a combination of clinical and experimental studies.

Ketoprofen is a non-steroid antiinflammatory drug with effects on peripherally as well as centrally generated pain. In a randomized, double-blind, prospective study on impingement patients treated with ASD, postoperative administration of ketoprofen showed short-term, but not long-term positive effects on pain, range of movement and satisfaction.

The status of the rotator cuff was found not to influence the postoperative results after ASD. Patients with an intact, partially ruptured or totally ruptured (<2cm) supraspinatus tendon did equally well, both 3 and 6 years after surgery. The results suggest that the presence of an inflamed bursa is more important for the symptoms than the cuff lesion.

In search for an experimental model we found that the shoulder region of the rat shows macroanatomical similarities to the human shoulder. Analysis of the innervation of the rat shoulder showed that the suprascapular nerve and some branches projecting to the subacromial space contain numerous C- and Ao-fibers. Many of these appeared to be polymodally nociceptive units or postganglionic sympathetic units as revealed by capsaicin and chemical sympathectomy. Such fibers are relevant for inflanunatory states.

In the normal rat substance P- (SP), calcitonin gene-related peptide- (CGRP) immunoreactive putative nociceptive fibers and neuropeptide Y- (NPY) and tyrosine hydroxylase- (TH) immunoreactive putative sympathetic fibers were widely distributed in the subacromial space. After induction of an acute subacromial inflammation with carrageenan, the presence of SP- and/or CGRP-immunoreactive fibers in the supraspinatus tendon was increased, with a maximum at two weeks. The results of labeling with the growth-associated protein GAP-43 indicated a de novo sprouting of nociceptive fibers in the tendon. But, radioimmunoassay measurements showed that the content of SP, CGRP and NPY in the supraspinatus tendon were normal or subnormal.

These results called for examination of subacromial tissue biopsies from  impingement patients. Innnunohistochemical analysis showed an increase of SP- and/or CGRP- immunoreactive nerve fibers and of NPY-immunoreactive nerve fibers in tendon tissue. The presence of corresponding neuropeptides was also elevated, as determined by RIA. The analysis also revealed an increase of SP and/or CGRP-immunoreactive nerve fibers and an elevated concentration of corresponding neuropeptides in bursal tissue.

sted, utgiver, år, opplag, sider
Linköping: Linköpings universitet, 2001. s. 87
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 658
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-25660 (URN)10036 (Lokal ID)91-721-9759-5 (ISBN)10036 (Arkivnummer)10036 (OAI)
Disputas
2001-02-16, Berzeliussalen, Universitetssjukhuset, Linköping, 09:00 (svensk)
Opponent
Tilgjengelig fra: 2009-10-08 Laget: 2009-10-08 Sist oppdatert: 2012-08-17bibliografisk kontrollert

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