liu.seSearch for publications in DiVA
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
The Supraspinatus Tendon: Clinical and histopathological aspects
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.
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 [en]
supraspinatus tendon, Subacromial impingement, shoulder pain, impingement syndrome, corticosteroid injection
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-5224ISBN: 91-7219-986-5 (print)OAI: oai:DiVA.org:liu-5224DiVA: diva2:21189
Public defence
2001-10-19, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2001-11-27 Created: 2001-11-27 Last updated: 2012-01-24Bibliographically approved
List of papers
1. Effect of steroid injections on the rotator cuff: An experimental study in rats
Open this publication in new window or tab >>Effect of steroid injections on the rotator cuff: An experimental study in rats
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.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13704 (URN)10.1016/S1058-2746(99)90141-6 (DOI)
Available from: 2001-11-27 Created: 2001-11-27 Last updated: 2009-08-21
2. Carrageenan-induced subacromial bursitis caused changes in the rat's rotator cuff
Open this publication in new window or tab >>Carrageenan-induced subacromial bursitis caused changes in the rat's rotator cuff
2001 (English)In: Journal of Orthopaedic Research, ISSN 0736-0266, Vol. 19, no 3, 441-447 p.Article in journal (Refereed) 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.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13705 (URN)10.1016/S0736-0266(00)90022-6 (DOI)
Available from: 2001-11-27 Created: 2001-11-27 Last updated: 2009-08-21
3. Intraoperative measurements of the subacromial distance
Open this publication in new window or tab >>Intraoperative measurements of the subacromial distance
2002 (English)In: Arthroscopy : the journal of arthroscopic & related surgery, ISSN 0749-8063, Vol. 18, no 4, 347-352 p.Article in journal (Refereed) 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.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13706 (URN)10.1053/jars.2002.30040 (DOI)
Available from: 2001-11-27 Created: 2001-11-27 Last updated: 2009-08-21
4. Change of calcifications after arthroscopic subacromial decompression
Open this publication in new window or tab >>Change of calcifications after arthroscopic subacromial decompression
1998 (English)In: Journal of shoulder and elbow surgery, ISSN 1058-2746, Vol. 7, no 3, 213-217 p.Article in journal (Refereed) 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.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13707 (URN)
Available from: 2001-11-27 Created: 2001-11-27 Last updated: 2009-08-21
5. Human biopsies in the rotator cuff disease
Open this publication in new window or tab >>Human biopsies in the rotator cuff disease
(English)Manuscript (preprint) (Other (popular science, discussion, etc.))
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13708 (URN)
Available from: 2001-11-27 Created: 2001-11-27 Last updated: 2010-01-14

Open Access in DiVA

fulltext(815 kB)795 downloads
File information
File name FULLTEXT01.pdfFile size 815 kBChecksum MD5
88027f8a6405bd027b57fc7633937ee53a8d5b8461f0111ded6a03f83f78bcef50fe7d60
Type fulltextMimetype application/pdf

Authority records BETA

Tillander, Bo

Search in DiVA

By author/editor
Tillander, Bo
By organisation
Orthopaedics and Sports MedicineFaculty of Health SciencesDepartment of Orthopaedics Linköping
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
Total: 795 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 798 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf