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Effect of steroid injections on the rotator cuff: An experimental study in rats
Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
Linköping University, Department of Clinical and Experimental Medicine, Molecular and Immunological Pathology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Pathology and Clinical Genetics.
Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
1999 (English)In: Journal of shoulder and elbow surgery, ISSN 1058-2746, Vol. 8, no 3, 271-274 p.Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
1999. Vol. 8, no 3, 271-274 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13704DOI: 10.1016/S1058-2746(99)90141-6OAI: oai:DiVA.org:liu-13704DiVA: diva2:21184
Available from: 2001-11-27 Created: 2001-11-27 Last updated: 2009-08-21
In thesis
1. The Supraspinatus Tendon: Clinical and histopathological aspects
Open this publication in new window or tab >>The Supraspinatus Tendon: Clinical and histopathological aspects
2001 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2001. 78 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 691
Keyword
supraspinatus tendon, Subacromial impingement, shoulder pain, impingement syndrome, corticosteroid injection
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-5224 (URN)91-7219-986-5 (ISBN)
Public defence
2001-10-19, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 09:00 (English)
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Supervisors
Available from: 2001-11-27 Created: 2001-11-27 Last updated: 2012-01-24Bibliographically approved

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Tillander, BoFranzén, LennartNorlin, Rolf

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Orthopaedics and Sports Medicine Faculty of Health SciencesDepartment of Orthopaedics LinköpingMolecular and Immunological Pathology Department of Clinical Pathology and Clinical Genetics
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