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The Supraspinatus Tendon: Clinical and histopathological aspects
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi och idrottsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Ortopedicentrum, Ortopedkliniken Linköping.
2001 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

The supraspinatus tendon is an important structure of the rotator cuff. Subacromial impingement is a common reason for shoulder pain. Despite extensive scientific work in this field, the cause of impingement syndrome is still not fully understood. The general aim of the present thesis was to generate new knowledge with respect to pathogenesis and treatment of impingement syndrome. A combination of animal and clinical studies were performed. Different methods were used such as histology, immunohistochemistry, development and assessment of a novel measuring device and clinical and radiological assessment.

Thirty rats were injected with triamcinolone or saline into the subacromial bursa. After five corticosteroid injections, we found focal inflammation, degradation and fragmentation of collagen bundles in the supraspinatus tendon, whereas the control specimens were normal (p=0.035).

Subacromial bursitis was induced by injections of carrageenan into the subacromial space (n=28). Fibrocartilaginous metaplasia and bony metaplasia were found in the supraspinatus tendon. Even in specimens with no histologic changes of the collagen bundles the staining for fibronectin was significantly increased.

The distance between the anterolateral acromion and the supraspinatus tendon was measured in patients with impingement syndrome intraoperatively (n=30) and in controls (instability, n=15). The mean value of the subacromial distance in controls was 16 mm, the 95% mean confidence limits between 14 and 18 mm. The mean value in the group of patients with impingement syndrome was 8 mm before and 16 mm after the decompression.

Fifty patients were reviewed after arthroscopic subacromial decompression. Twenty-five showed calcific deposits in the rotator cuff on radiographs preoperatively. In 13 patients the calcific deposits totally disappeared postoperatively. In another six patients the calcifications had decreased in size. Four patients still showed calcifications, which were 5 mm or greater in size. The postoperative results measured by the Constant score were almost identical in the calcific and the non-calcific groups. Tillander 010916 8 Human surgical supraspinatus tendon specimens were studied from patients with impingement (n=16), ruptured supraspinatus tendons (n=7) and controls (n=10). Degradation of tendinous tissue and fibrin were found only in some specimens from ruptures. The difference in fibronectin staining was significant between controls and patients with a rupture (p=0.002). Fibrosis and thinning of fascicles seemed to be a more non-specific finding, appearing in control, impingement and rupture specimens.

In conclusion, subacromial corticosteroid injections may cause rupture of the supraspinatus tendon. Metaplasia of the supraspinatus tendon may play a role in the pathogenesis of impingement and rupture of the supraspinatus tendon. The subacromial distance can be measured intraoperatively and was shown to be lower in patients with impingement than in patients with instability. Calcifications disappear or decrease in size after arthroscopic subacromial decompression and do not seem to influence the postoperative outcome in patients with impingement. Degradation of tendon tissue, fibrin and fibronectin appear to be signs of tendon degeneration, whereas fibrosis and thinning of fascicles were found also in controls.

Ort, förlag, år, upplaga, sidor
Linköping: Linköping University Electronic Press, 2001. , s. 78
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 691
Nyckelord [en]
supraspinatus tendon, Subacromial impingement, shoulder pain, impingement syndrome, corticosteroid injection
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
URN: urn:nbn:se:liu:diva-5224ISBN: 91-7219-986-5 (tryckt)OAI: oai:DiVA.org:liu-5224DiVA, id: diva2:21189
Disputation
2001-10-19, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 09:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2001-11-27 Skapad: 2001-11-27 Senast uppdaterad: 2023-01-24Bibliografiskt granskad
Delarbeten
1. Effect of steroid injections on the rotator cuff: An experimental study in rats
Öppna denna publikation i ny flik eller fönster >>Effect of steroid injections on the rotator cuff: An experimental study in rats
1999 (Engelska)Ingår i: Journal of shoulder and elbow surgery, ISSN 1058-2746, Vol. 8, nr 3, s. 271-274Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

The aim of this study was to evaluate the effects of repeated steroid injections into the subacromial space. Thirty rats were injected either 3 or 5 times with triamcinolone in a dosage equivalent to that given to human beings or 3 or 5 times with saline into the subacromial space. One rat received no injection. The supraspinatus and infraspinatus tendons were evaluated macroscopically and microscopically. Two different staining methods were used on each sample including hematoxylin eosin and Miller's elastin/van Gieson's solution. After 5 steroid injections, we found focal inflammation, necrosis, and fragmentation of collagen bundles in the tendon in 4 of 7 rats. The tendons of the controls showed a normal structure (P < .05). There were no pathologic changes among the rats that were injected with triamcinolone 3 times. These results show that repeated subacromial injections of triamcinolone may cause damage to the rotator cuff of the rat. This finding may indicate cautious use of subacromial steroid injections in human beings.

Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:liu:diva-13704 (URN)10.1016/S1058-2746(99)90141-6 (DOI)
Tillgänglig från: 2001-11-27 Skapad: 2001-11-27 Senast uppdaterad: 2009-08-21
2. Carrageenan-induced subacromial bursitis caused changes in the rat's rotator cuff
Öppna denna publikation i ny flik eller fönster >>Carrageenan-induced subacromial bursitis caused changes in the rat's rotator cuff
2001 (Engelska)Ingår i: Journal of Orthopaedic Research, ISSN 0736-0266, Vol. 19, nr 3, s. 441-447Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

This study was designed to investigate the histologic expression of the rat's supra- and infraspinatus tendons in carrageenan-induced subacromial bursitis. Thirty-two rats received subacromial injections with carrageenan (n = 28) or saline (n = 4). The tendons were analysed microscopically after staining with hematoxyline eosin, Van Giesons hematoxyline and immunofluorescent staining of fibronectin and fibrinogen. In the controls (saline × 10) and group A (carrageenan × 5) there were no changes in the tendons. In group B (carrageenan × 10) 3/8 rats showed macrophages between the collagen fibres and an increased staining of fibronectin. In group C (double dosis carrageenan) all rats had signs of fibrocartilaginous metaplasia in the supraspinatus tendon. In eight of these specimens even bony metaplasia was seen. The infraspinatus tendon showed fibrosis but no fibro-cartilaginous metaplasia. The results showed that iatrogenic bursitis after carrageenan subacromial injections was associated with marked changes of the supraspinatus tendon.

Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:liu:diva-13705 (URN)10.1016/S0736-0266(00)90022-6 (DOI)
Tillgänglig från: 2001-11-27 Skapad: 2001-11-27 Senast uppdaterad: 2009-08-21
3. Intraoperative measurements of the subacromial distance
Öppna denna publikation i ny flik eller fönster >>Intraoperative measurements of the subacromial distance
2002 (Engelska)Ingår i: Arthroscopy : the journal of arthroscopic & related surgery, ISSN 0749-8063, Vol. 18, nr 4, s. 347-352Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Purpose: The purpose of this study was 2-fold: to document the accuracy of a new measuring device and to intraoperatively compare the subacromial distance between controls and patients with impingement syndrome before and after arthroscopic subacromial decompression (ASD).

Type of Study: Clinical study.

Methods: When performing an ASD, it is important that bone resection is adequate. Today the correct subacromial distance after bone resection is only assessed by eye, directly or indirectly. The subacromial distance was measured between the anterolateral corner of the acromion and the supraspinatus tendon in the lateral decubitus position. The device was inserted 2 to 3 cm below the anterolateral acromion. There was no subacromial pathology among the controls (n = 15, mean age, 28 years). In 30 patients with impingement syndrome (average age, 53 years) an ASD was performed. The subacromial distance was measured after bursectomy and then after bone resection. Intraindividual and interindividual assessment was performed.

Results: The mean value of the subacromial distance in controls was 16 mm, the 95% confidence limits between 14 and 18 mm. The mean value in the group of patients with impingement syndrome was 8 mm before and 16 mm after the decompression. Due to the pressure within the subacromial space, the subacromial distance increased 1 mm. Intraindividual measurements never varied more than 1 mm (n = 5). The correlation coefficient between the measurements by both authors was 0.99.

Conclusions: In this study, we assessed and described the use of a measuring device that enables the surgeon to quantify the subacromial distance before and after bone resection. After bone resection, the mean value of the subacromial distance was well within the control values. The amount of bone resected varied from 5 to 13 mm. This new device enables documentation in clinical work as well as in research.

Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:liu:diva-13706 (URN)10.1053/jars.2002.30040 (DOI)
Tillgänglig från: 2001-11-27 Skapad: 2001-11-27 Senast uppdaterad: 2009-08-21
4. Change of calcifications after arthroscopic subacromial decompression
Öppna denna publikation i ny flik eller fönster >>Change of calcifications after arthroscopic subacromial decompression
1998 (Engelska)Ingår i: Journal of shoulder and elbow surgery, ISSN 1058-2746, Vol. 7, nr 3, s. 213-217Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Fifty patients were reviewed after arthroscopic subacromial decompression. Twenty-five had calcific deposits in the rotator cuff visible on x-ray evaluation. Each patient with calcification was matched with a patient without calcification who had a similar state of the rotator cuff, date of surgery, age, and sex. The calcific deposits were left untouched in all cases. No significant difference was found in the postoperative outcome between the patients in the two groups measured by the Constant score. Before surgery 7 (28%) patients had calcifications of < 5 mm, and 18 (72%) patients had calcifications that were > or = 5 mm. At a 2-year follow-up (n = 24) these figures were 20 (83%) and 4 (17%), respectively (p < 0.001). Postoperative x-ray evaluations revealed a disappearance or decrease in size of the calcific deposits in 19 (79%) of the patients. These results provide new information on the course of calcifying tendinitis, which may indicate that we can leave calcific deposits untouched within the rotator cuff when performing arthroscopic subacromial decompression.

Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:liu:diva-13707 (URN)
Tillgänglig från: 2001-11-27 Skapad: 2001-11-27 Senast uppdaterad: 2009-08-21
5. Human biopsies in the rotator cuff disease
Öppna denna publikation i ny flik eller fönster >>Human biopsies in the rotator cuff disease
(Engelska)Manuskript (preprint) (Övrig (populärvetenskap, debatt, mm))
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:liu:diva-13708 (URN)
Tillgänglig från: 2001-11-27 Skapad: 2001-11-27 Senast uppdaterad: 2010-01-14

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