Claudio Chillemi1, Vincenzo Petrozza2, Vincenzo Franceschini3, Luca Garro4, Alberto Pacchiarotti5, Natale Porta2, Mirko Cirenza2, Francesco Salate Santone6, Alessandro Castagna7. 1. Department of Orthopaedic Surgery, Istituto Chirurgico Ortopedico Traumatologico (ICOT), Latina, Italy. c_chillemi@libero.it. 2. Histology Unit, Department of Medico-Surgical Sciences and Biotechnologies, ICOT Latina, Sapienza University of Rome, Latina, Italy. 3. Department of Orthopaedics and Traumatology, ICOT, Sapienza University of Rome, Latina, Italy. 4. Department of Orthopaedic Surgery, University of Rome Tor Vergata, Rome, Italy. 5. Department of Histopathology, Istituto Chirurgico Ortopedico Traumatologico (ICOT), Latina, Italy. 6. Value Lab S.p.a, Rome, Italy. 7. Istituto Clinico Humanitas IRCSS, Rozzano, MI, Italy.
Abstract
PURPOSE: To evaluate a possible association of shoulder pain with the clinical features and the histopathological changes occurring in the ruptured tendon and subacromial bursa of patients with rotator cuff tear. METHODS: One hundred and eighty patients were clinically evaluated with the constant score and the visual analogue pain scale. Radiographs and MRI were performed. The chronology of the rupture, the muscle fatty degeneration according to Goutallier's scale and the tear size were evaluated. For each patient, a biopsy of the supraspinatus tendon and subacromial bursa was performed during arthroscopic rotator cuff tear repair and the specimens were histopathologically analysed. RESULTS: Clinically, the shoulder was more painful in females, in the presence of a chronic cuff lesion and a low Goutallier's grade (P < 0.05). No association was found between pain and age of the patient and between pain and tear size. Histologically, hypertrophy and inflammation of the tendon and hypertrophy, inflammation, oedema and necrosis of the subacromial bursa were directly associated with pain (P < 0.05). Pain decreased significantly in the presence of fatty metaplasia and necrosis of the tendon (P < 0.05). CONCLUSIONS: This study defines the main clinical and histopathological features of painful rotator cuff tear. In particular, a greater association of pain was observed with the histopathological changes in the bursa compared with those in the rotator cuff. Considering that the bursa plays also an essential role during the healing process, this "new" role of the subacromial bursa as pain generator has important repercussions in both pharmacological and surgical treatments of rotator cuff tears. LEVEL OF EVIDENCE: IV.
PURPOSE: To evaluate a possible association of shoulder pain with the clinical features and the histopathological changes occurring in the ruptured tendon and subacromial bursa of patients with rotator cuff tear. METHODS: One hundred and eighty patients were clinically evaluated with the constant score and the visual analogue pain scale. Radiographs and MRI were performed. The chronology of the rupture, the muscle fatty degeneration according to Goutallier's scale and the tear size were evaluated. For each patient, a biopsy of the supraspinatus tendon and subacromial bursa was performed during arthroscopic rotator cuff tear repair and the specimens were histopathologically analysed. RESULTS: Clinically, the shoulder was more painful in females, in the presence of a chronic cuff lesion and a low Goutallier's grade (P < 0.05). No association was found between pain and age of the patient and between pain and tear size. Histologically, hypertrophy and inflammation of the tendon and hypertrophy, inflammation, oedema and necrosis of the subacromial bursa were directly associated with pain (P < 0.05). Pain decreased significantly in the presence of fatty metaplasia and necrosis of the tendon (P < 0.05). CONCLUSIONS: This study defines the main clinical and histopathological features of painful rotator cuff tear. In particular, a greater association of pain was observed with the histopathological changes in the bursa compared with those in the rotator cuff. Considering that the bursa plays also an essential role during the healing process, this "new" role of the subacromial bursa as pain generator has important repercussions in both pharmacological and surgical treatments of rotator cuff tears. LEVEL OF EVIDENCE: IV.
Authors: Pascal Boileau; François Baqué; Laure Valerio; Philip Ahrens; Christopher Chuinard; Christophe Trojani Journal: J Bone Joint Surg Am Date: 2007-04 Impact factor: 5.284
Authors: Daichi Morikawa; Matthew R LeVasseur; S Brandon Luczak; Michael R Mancini; Nicholas Bellas; Mary Beth R McCarthy; Mark P Cote; Daniel P Berthold; Lukas N Muench; Augustus D Mazzocca Journal: Arthrosc Sports Med Rehabil Date: 2021-05-14
Authors: Teemu V Karjalainen; Nitin B Jain; Juuso Heikkinen; Renea V Johnston; Cristina M Page; Rachelle Buchbinder Journal: Cochrane Database Syst Rev Date: 2019-12-09
Authors: Matthew R LeVasseur; Benjamin C Hawthorne; Michael R Mancini; Mary Beth R McCarthy; Ian J Wellington; Mark P Cote; Olga Solovyova; Vincent J Williams; Augustus D Mazzocca Journal: Arthrosc Sports Med Rehabil Date: 2021-09-08