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Morimoto T, Izumi M, Aso K, Ikeuchi M. Role of tear size and tendon degeneration for development of pain in rat models of rotator cuff tear. J Shoulder Elbow Surg 2024; 33:1473-1482. [PMID: 38311102 DOI: 10.1016/j.jse.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/12/2023] [Accepted: 12/17/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND Rotator cuff tear (RCT) is a frequent etiology of shoulder pain and disability; however, the triggers for the onset and aggravation of pain remain obscure. In this study, we established novel rat RCT models to examine the impact of tear size and tendon degeneration on pain. METHODS Fifty-five adult male Sprague-Dawley rats were allocated into 4 study groups: large tear (L group, n = 10), small tear (S group, n = 15), small tear with scratching (S+ group n = 15), and sham surgery (Sham group, n = 15). Pain-related behaviors were evaluated by weight distribution of forelimbs during a 5-minute free gait using a dynamic weight-bearing apparatus at 2, 4, 6, and 8 weeks. Calcitonin gene-related peptide (CGRP) expressions in ipsilateral dorsal root ganglion (DRG) neurons of C4, C5, and C6 were evaluated at 4 and 8 weeks. The area of scar tissues around the torn tendon, infiltration of inflammatory cells, and severity of tendon degeneration (modified Bonar score) were histologically assessed at 4 and 8 weeks. Additionally, enzyme-linked immunosorbent assay (ELISA) was conducted to evaluate the levels of cyclooxygenase-2 (COX-2) and nerve growth factor (NGF) expression in torn tendons and surrounding tissues at 4 weeks. RESULTS The weight distribution ratio (ipsilateral and contralateral side) was significantly decreased in the L and S+ group compared with its baseline and Sham group (P < .05), but the S group showed no significant difference compared with the Sham. The ratio of CGRP-immunoreactive neurons in the DRGs was significantly higher in the L and S+ groups than in the S and Sham groups. The histologic assessment indicated that scar tissue formation was more extensive in the L group than in the S and S+ groups. Still, there was no significant difference between the S and S+ groups. The modified Bonar score was considerably higher in the S+ group than in the S group. Furthermore, ELISA analysis demonstrated no significant disparity in COX-2 levels between the groups; however, NGF levels were substantially higher in the S+ group than in the S and Sham groups. CONCLUSION The present study provides compelling evidence that large RCT is strongly associated with heightened pain severity in a rat model. Nevertheless, even a small tear can significantly aggravate pain when the torn tendon is degenerated. CGRP upregulation driven by peripheral NGF possibly played a pivotal role in the genesis and exacerbation of pain in small RCT.
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Affiliation(s)
- Toru Morimoto
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Masashi Izumi
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan; Department of Rehabilitation, Kochi Medical School Hospital, Kochi University, Nankoku, Japan.
| | - Koji Aso
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Masahiko Ikeuchi
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan; Department of Rehabilitation, Kochi Medical School Hospital, Kochi University, Nankoku, Japan
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Klatte-Schulz F, Bormann N, Bonell A, Al-Michref J, Nguyen HL, Klöckner P, Thiele K, Moroder P, Seifert M, Sawitzki B, Wildemann B, Duda GN. Pro-Resolving Mediators in Rotator Cuff Disease: How Is the Bursa Involved? Cells 2023; 13:17. [PMID: 38201221 PMCID: PMC10778346 DOI: 10.3390/cells13010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/08/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
So far, tendon regeneration has mainly been analyzed independent from its adjacent tissues. However, the subacromial bursa in particular appears to influence the local inflammatory milieu in the shoulder. The resolution of local inflammation in the shoulder tissues is essential for tendon regeneration, and specialized pro-resolving mediators (SPMs) play a key role in regulating the resolution of inflammation. Here, we aimed to understand the influence of the bursa on disease-associated processes in neighboring tendon healing. Bursa tissue and bursa-derived cells from patients with intact, moderate and severe rotator cuff disease were investigated for the presence of pro-resolving and inflammatory mediators, as well as their effect on tenocytes and sensitivity to mechanical loading by altering SPM signaling mediators in bursa cells. SPM signal mediators were present in the bursae and altered depending on the severity of rotator cuff disease. SPMs were particularly released from the bursal tissue of patients with rotator cuff disease, and the addition of bursa-released factors to IL-1β-challenged tenocytes improved tenocyte characteristics. In addition, mechanical loading modulated pro-resolving processes in bursa cells. In particular, pathological high loading (8% strain) increased the expression and secretion of SPM signaling mediators. Overall, this study confirms the importance of bursae in regulating inflammatory processes in adjacent rotator cuff tendons.
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Affiliation(s)
- Franka Klatte-Schulz
- Julius Wolff Institut, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
- BIH-Center for Regenerative Therapies, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Nicole Bormann
- Julius Wolff Institut, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
- BIH-Center for Regenerative Therapies, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Aysha Bonell
- Julius Wolff Institut, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
- BIH-Center for Regenerative Therapies, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Jasmin Al-Michref
- Julius Wolff Institut, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Hoang Le Nguyen
- Julius Wolff Institut, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Pascal Klöckner
- Julius Wolff Institut, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Kathi Thiele
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
- Vivantes Auguste Viktoria Klinikum, 12157 Berlin, Germany
| | | | - Martina Seifert
- Institute of Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt University of Berlin, 13353 Berlin, Germany
| | - Birgit Sawitzki
- Institute of Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt University of Berlin, 13353 Berlin, Germany
- Center of Immunomics, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Britt Wildemann
- Julius Wolff Institut, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
- Experimental Trauma Surgery, Department of Trauma-, Hand- and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany
| | - Georg N. Duda
- Julius Wolff Institut, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
- BIH-Center for Regenerative Therapies, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
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Lei M, Wang Y, Chen Q, Huang P, Li Y, Jia Y, Meng D. Changes in serum levels of pain mediators in hemiplegic shoulder pain. Brain Behav 2023; 13:e3289. [PMID: 37864374 PMCID: PMC10726773 DOI: 10.1002/brb3.3289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023] Open
Abstract
OBJECTIVE To provide a new insight into the diagnosis and treatment of hemiplegic shoulder pain (HSP) by investigating changes in serum pain mediators. DESIGN Cross-sectional study. SUBJECTS/PATIENTS Shoulder pain group (n = 34) and control group (n = 21). METHODS Pain-free shoulder mobility, anxiety status, depression status, and shoulder pain were measured by passive range of motion (PROM), self-rating anxiety scale, self-rating depression scale (SDS), and visual analog scale, respectively. The enzyme-linked immunosorbent assay was used to test the serum pain mediators, including interleukin (IL)-1β, IL-2, IL-6, IL-10, nerve growth factor (NGF), tumor necrosis factor-α (TNF-α), substance P (SP), calcitonin gene-related peptide (CGRP), bradykinin (BK), 5-hydroxytryptamine (5-HT), prostaglandin E2 (PGE2), and lysophosphatidic acid (LPA). RESULTS Shoulder pain group pain-free PROM significantly lower than control (p < .01), and SDS index score of shoulder pain group was significantly higher than control (p < .05). The rate of spasticity in the flexor elbow muscles is higher in shoulder pain group (p < .01). CGRP, IL-10, and IL-2 were significantly upregulated in shoulder pain group compared with control (p < .01), whereas NGF, TNF-α, IL-6, 5-HT, PGE2, SP, LPA, BK, and IL-1β were significantly decreased (p < .01). CONCLUSION Patients with HSP have a higher risk of joint mobility disorders and depression; spasticity may be an important factor in the development of shoulder pain; CGRP is thought to be the major pain mediator in HSP, and HSP may not be inflammatory.
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Affiliation(s)
- Mincong Lei
- Rehabilitation CenterThe first Affiliated Hospital with Nanjing Medical UniversityNanjingChina
- Children's Hospital Affiliated to Zhejiang University School of MedicineHangzhouChina
| | - Yidi Wang
- Department of EpidemiologySchool of Public Health, Nanjing Medical UniversityNanjingChina
| | - Qian Chen
- Department of Rehabilitation MedicineNanjing Qixia District HospitalNanjingChina
| | - Peng Huang
- Department of EpidemiologySchool of Public Health, Nanjing Medical UniversityNanjingChina
| | - Yige Li
- The Second Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Yuanyuan Jia
- Rehabilitation CenterThe first Affiliated Hospital with Nanjing Medical UniversityNanjingChina
| | - Dianhuai Meng
- Rehabilitation CenterThe first Affiliated Hospital with Nanjing Medical UniversityNanjingChina
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Dai X, Yuan M, Dang M, Liu D, Fei W. Development and Validation of a Predictive Model for Chronic Postsurgical Pain After Arthroscopic Rotator Cuff Repair: A Prospective Cohort Study. J Pain Res 2023; 16:3273-3288. [PMID: 37790188 PMCID: PMC10544136 DOI: 10.2147/jpr.s423110] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023] Open
Abstract
Purpose Chronic pain management continues to present a significant challenge following arthroscopic shoulder surgery. Our purpose was to detect chronic postsurgical pain (CPSP) in patients who had undergone arthroscopic rotator cuff repair (ARCR) and develop a nomogram capable of predicting the associated risk. Patients and Methods We collected the demographic and clinical data of 240 patients undergoing ARCR in our hospital from January 2021 to May 2022. The pain level was monitored and evaluated three months after ARCR. LASSO regression was used to screen out pain-predicting factors, which were subsequently used to construct a nomogram. Internal validation was carried out using Bootstrap resampling. The data of 78 patients who underwent ARCR in our hospital from August 2022 to December 2022 were also collected for external verification of the nomogram. The predictive model was evaluated using the receiver operating characteristic curve (ROC), calibration curve, and decision curve analysis (DCA). Results Age, duration of preoperative shoulder pain (DPSP), C-reactive protein (CRP), number of tear tendons, and American Shoulder and Elbow Surgical Score (ASES) were screened by LASSO regression as predictive factors for CPSP. These factors were then used to construct a chronic pain risk nomogram. The area under the curve (AUC) of the predictive and validation models were 0.756 (95% CI: 0.6386-0.8731) and 0.806 (95% CI: 0.6825-0.9291), respectively. Furthermore, the calibration curves and decision curve analysis (DCA) for both models indicated strong performance, affirming the reliability of this predictive model. Conclusion The CPSP risk model that has been developed exhibits strong predictive capabilities and practical utility. It offers valuable support to clinical healthcare professionals in making informed treatment decisions, reducing the unnecessary use of analgesic drugs, and optimizing the allocation of medical resources.
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Affiliation(s)
- Xiaomei Dai
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, People’s Republic of China
| | - Meijuan Yuan
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, People’s Republic of China
| | - Mengbo Dang
- Dalian Medical University, Dalian, People’s Republic of China
| | - Dianwei Liu
- Dalian Medical University, Dalian, People’s Republic of China
| | - Wenyong Fei
- Department of Orthopedics and Sports Medicine, Northern Jiangsu People’s Hospital, Affiliated to Yangzhou University, Yangzhou, People’s Republic of China
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Lo CN, Leung BPL, Sanders G, Li MWM, Ngai SPC. The major pain source of rotator cuff-related shoulder pain: A narrative review on current evidence. Musculoskeletal Care 2023; 21:285-293. [PMID: 37316968 DOI: 10.1002/msc.1719] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Rotator cuff-related shoulder pain (RCRSP) was proposed to have a complex pain mechanism, but the exact aetiology is still unclear. A recent review summarised the updated research to analyse the traditional concept of shoulder impingement which may not be accurate. Current studies have demonstrated that mechanical factors including a reduction in subacromial space, scapular dyskinesia and different acromial shapes are unlikely directly contributing to RCRSP. AIMS Since the precise RCRSP pain mechanism remains unclear, the aim of this narrative review is to discuss possible sources of pain contributing to RCRSP according to the mechanisms-based pain classifications. RESULTS AND DISCUSSION Research findings on potential mechanical nociceptive factors of RCRSP are conflicting; investigations of neuropathic and central pain mechanisms of RCRSP are limited and inconclusive. Overall, available evidence has indicated moderate to strong correlations between RCRSP and chemical nociceptive sources of pain. CONCLUSION Results from current research may provide new directions for future studies on the aetiology of RCRSP and its clinical management towards a biochemical view instead of the traditional mechanical hypothesis.
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Affiliation(s)
- Chi Ngai Lo
- Family Care Physiotherapy Clinic, Clementi, Singapore
| | - Bernard Pui Lam Leung
- Health and Social Sciences Cluster, Singapore Institute of Technology, Dover, Singapore
- Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Grant Sanders
- Sanders Chiropractic and Fitness, Ohio, Bainbridge, USA
| | | | - Shirley P C Ngai
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Marcianò G, Vocca C, Rania V, Citraro R, De Sarro G, Gallelli L. Metalloproteases in Pain Generation and Persistence: A Possible Target? Biomolecules 2023; 13:biom13020268. [PMID: 36830637 PMCID: PMC9953417 DOI: 10.3390/biom13020268] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/15/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
Matrix metalloproteinases (MMPs) are a large family of zinc-dependent proteolytic enzymes associated with extracellular matrix protein turnover and tissue degradation. They participate to many different physiological reactions but are also hyperactivated in several diseases. Various literature studies have documented that MMPs play a role in the modulation of neuropathic and nociceptive pain. The heterogeneity of clinical and pre-clinical data is an important issue in this experimental context. Despite the presence of a good number of studies on MMP inhibitors, these drugs showed scarce efficacy and relevant side effects. In the present manuscript, we reviewed studies in the literature that define a possible role of MMPs in pain and the effects of their modulation.
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Affiliation(s)
- Gianmarco Marcianò
- Operative Unit of Pharmacology and Pharmacovigilance, “Mater Domini” University Hospital, 88100 Catanzaro, Italy
| | - Cristina Vocca
- Operative Unit of Pharmacology and Pharmacovigilance, “Mater Domini” University Hospital, 88100 Catanzaro, Italy
| | - Vincenzo Rania
- Operative Unit of Pharmacology and Pharmacovigilance, “Mater Domini” University Hospital, 88100 Catanzaro, Italy
| | - Rita Citraro
- Operative Unit of Pharmacology and Pharmacovigilance, “Mater Domini” University Hospital, 88100 Catanzaro, Italy
- Research Center FAS@UMG, Department of Health Science, University Magna Graecia, 88100 Catanzaro, Italy
| | - Giovambattista De Sarro
- Operative Unit of Pharmacology and Pharmacovigilance, “Mater Domini” University Hospital, 88100 Catanzaro, Italy
- Research Center FAS@UMG, Department of Health Science, University Magna Graecia, 88100 Catanzaro, Italy
| | - Luca Gallelli
- Operative Unit of Pharmacology and Pharmacovigilance, “Mater Domini” University Hospital, 88100 Catanzaro, Italy
- Research Center FAS@UMG, Department of Health Science, University Magna Graecia, 88100 Catanzaro, Italy
- Medifarmagen SRL, Department of Health Science, “Mater Domini” University Hospital, 88100 Catanzaro, Italy
- Correspondence: ; Tel.: +39-0961-712322
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Sachinis NP, Yiannakopoulos CK, Chalidis B, Kitridis D, Givissis P. Biomolecules Related to Rotator Cuff Pain: A Scoping Review. Biomolecules 2022; 12:1016. [PMID: 35892325 PMCID: PMC9332043 DOI: 10.3390/biom12081016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/16/2022] [Accepted: 07/19/2022] [Indexed: 02/04/2023] Open
Abstract
The pathophysiology of pain in patients suffering from rotator cuff (RC) tendinopathy or tears has been examined in various ways. Several molecules from tissue samples taken from the subacromial bursa, supraspinatus tendon, glenohumeral joint fluid, and synovium as well as from peripheral blood have been investigated. This article explores these studies, the assessed biomarkers, and groups their results according to the status of tendon integrity (tendinopathy or tear). Through a structured PubMed database search, 9 out of 658 articles were reviewed. Interleukins, mostly IL-1b and its antagonist, IL-1ra, matrix Metalloproteinases (MMPs), the vascular endothelial growth factor (VEGF) and TNF-a are biomarkers directly searched for correlation to pain level. Most studies agree that IL-1b is directly positively correlated to the degree of pain in patients with RC tendinopathy, especially when the examined sample is taken from the subacromial bursa. VEGF, and TNF-a have been related to shoulder pain preoperatively and TNF-a has also been linked with sleep disturbance. Further studies pointing to more biomarkers taken from the subacromial bursa or tendon directly relating to pain degree are warranted.
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Affiliation(s)
| | - Christos K. Yiannakopoulos
- School of Physical Education & Sports Science, National & Kapodistrian University of Athens, 15772 Athens, Greece;
| | - Byron Chalidis
- “Georgios Papanikolaou” Hospital, 57010 Thessaloniki, Greece; (B.C.); (D.K.); (P.G.)
| | - Dimitrios Kitridis
- “Georgios Papanikolaou” Hospital, 57010 Thessaloniki, Greece; (B.C.); (D.K.); (P.G.)
| | - Panagiotis Givissis
- “Georgios Papanikolaou” Hospital, 57010 Thessaloniki, Greece; (B.C.); (D.K.); (P.G.)
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Xu Z, Fang Y, Chen Y, Zhao Y, Wei W, Teng C. Hydrogel Development for Rotator Cuff Repair. Front Bioeng Biotechnol 2022; 10:851660. [PMID: 35782490 PMCID: PMC9240348 DOI: 10.3389/fbioe.2022.851660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Rotator cuff tears (RCTs) are common in shoulder disease and disability. Despite significant advances in surgical repair techniques, 20–70% of patients still have postoperative rotator cuff dysfunction. These functional defects may be related to retear or rotator cuff quality deterioration due to tendon retraction and scar tissue at the repair site. As an effective delivery system, hydrogel scaffolds may improve the healing of RCTs and be a useful treatment for irreparable rotator cuff injuries. Although many studies have tested this hypothesis, most are limited to laboratory animal experiments. This review summarizes differences in hydrogel scaffold construction, active ingredients, and application methods in recent research. Efforts to determine the indications of hydrogel scaffolds (with different constructions and cargos) for various types of RCTs, as well as the effectiveness and reliability of application methods and devices, are also discussed.
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Affiliation(s)
- Zhengyu Xu
- Department of Orthopaedics, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Yifei Fang
- Department of Orthopaedics, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Yao Chen
- Department of Orthopaedics, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Yushuang Zhao
- Department of Orthopaedics, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Wei Wei
- Department of Orthopaedics, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
- Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Wei Wei, ; Chong Teng,
| | - Chong Teng
- Department of Orthopaedics, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
- *Correspondence: Wei Wei, ; Chong Teng,
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Blood Flow in the Anterior Humeral Circumflex Artery Reflects Synovial Inflammation of the Shoulder Joint in Rotator Cuff Tears. JSES Int 2022; 6:623-630. [PMID: 35813140 PMCID: PMC9264028 DOI: 10.1016/j.jseint.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background An association has been reported between rotator cuff tear and inflammation. We hypothesized that blood flow in the anterior humeral circumflex artery would reflect synovial inflammation in the shoulder. This study aimed to clarify the association of blood flow in the anterior humeral circumflex artery with synovial inflammation and shoulder pain in patients with rotator cuff tears. Methods In this prospective, cross-sectional study, tissue samples from the synovium in the rotator interval were obtained from 33 patients undergoing arthroscopic rotator cuff repair. Reverse transcription-polymerase chain reaction and real-time polymerase chain reaction were performed to determine the messenger RNA expression of inflammatory mediators, growth factors, and matrix metalloproteinases. Additional tissue samples were fixed for histologic evaluation. Before surgery, we measured the peak systolic velocity in the anterior humeral circumflex artery using pulse Doppler ultrasonography. Results The peak systolic velocity in the anterior humeral circumflex artery was positively correlated with the messenger RNA expression of interleukin 1β, interleukin 8, and matrix metalloproteinase 3 genes (r = 0.49, P = .004; r = 0.55, P = .001; and r = 0.39, P = .026, respectively), as well as histologic synovitis scores (r = 0.48, P = .005). Additionally, it was significantly higher in patients with resting pain than in those without resting pain (P = .048). Conclusion The peak systolic velocity in the anterior humeral circumflex artery is associated with the severity of synovial inflammation. Our results suggest that assessing the peak systolic velocity in the anterior humeral circumflex artery is useful for evaluating the severity of synovial inflammation.
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Muneshige K, Uchida K, Kenmoku T, Tazawa R, Nakawaki M, Ishii D, Inoue G, Takaso M. Elevation of MMP1 and ADAMTS5 mRNA expression in glenohumeral synovia of patients with hypercholesterolemia. J Orthop Surg Res 2022; 17:97. [PMID: 35168639 PMCID: PMC8848821 DOI: 10.1186/s13018-022-02998-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Epidemiological studies have reported a positive association between hypercholesterolemia and shoulder disease. Previous studies have focused on the effect of hypercholesterolemia on tendinopathy. Moreover, hypercholesterolemia has also been linked to joint pathology in the knee and hand. However, the effect of hyperlipidemia on glenohumeral joint remain unclear. A hypercholesterolemic condition has been reported to alter levels of A Disintegrin and Metalloprotease with Thrombospondin Motifs (ADAMTSs) and matrix metalloproteases (MMPs) in synovium of the knee joint. Here, we evaluated the mRNA expression of ADAMTSs and MMPs in the glenohumeral synovium of patients with and without hypercholesterolemia. Methods Study participants were 73 patients who underwent arthroscopic rotator cuff repair for degenerative rotator cuff tears. They were divided into two groups according to total cholesterol (TC) and triglyceride levels. Synovial membrane samples were harvested at the rotator interval during surgery, and mRNA expression levels of the aggrecanases ADAM-TS4 and ADAM-TS5 and MMPs (MMP-1, 3, 9, and 13) were analyzed quantitatively. Results ADAM-TS5 and MMP1 mRNA levels were significantly higher in the high TC group than in the low TC group (P = 0.023 and P = 0.025, respectively). In contrast, no significant differences were observed in ADAMTS4 or MMPs 3, 9, and 13 (ADAMTS4, P = 0.547; MMP3, P = 0.55; MMP9, P = 0.521; and MMP13, P = 0.785). Conclusion Hypercholesterolemia may alter MMP1 and ADAMTS5 expression in the synovium of the glenohumeral joint.
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Affiliation(s)
- Kyoko Muneshige
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-ku, Kitasato, Sagamihara City, Kanagawa, 252-0374, Japan.
| | - Kentaro Uchida
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-ku, Kitasato, Sagamihara City, Kanagawa, 252-0374, Japan.,Shonan University of Medical Sciences Research Institute, Nishikubo 500, Chigasaki City, Kanagawa, 253-0083, Japan
| | - Tomonori Kenmoku
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-ku, Kitasato, Sagamihara City, Kanagawa, 252-0374, Japan
| | - Ryo Tazawa
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-ku, Kitasato, Sagamihara City, Kanagawa, 252-0374, Japan
| | - Mitsufumi Nakawaki
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-ku, Kitasato, Sagamihara City, Kanagawa, 252-0374, Japan
| | - Daisuke Ishii
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-ku, Kitasato, Sagamihara City, Kanagawa, 252-0374, Japan
| | - Gen Inoue
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-ku, Kitasato, Sagamihara City, Kanagawa, 252-0374, Japan
| | - Masashi Takaso
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-ku, Kitasato, Sagamihara City, Kanagawa, 252-0374, Japan
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Histological and molecular features of the subacromial bursa of rotator cuff tears compared to non-tendon defects: a pilot study. BMC Musculoskelet Disord 2021; 22:877. [PMID: 34649550 PMCID: PMC8518155 DOI: 10.1186/s12891-021-04752-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 10/01/2021] [Indexed: 01/02/2023] Open
Abstract
Background The role of the subacromial bursa in the development or healing of shoulder pathologies is unclear. Due to this limited knowledge, we aimed to understand specific reactions of the subacromial bursa according to rotator cuff (RC) pathologies compared to non-tendon defects of the shoulder. We hypothesized that the tissue composition and inflammatory status of the bursa are likely to vary between shoulder pathologies depending on the presence and the extent of RC lesion. Method Bursa samples from patients with either 1) shoulder instability with intact RC (healthy bursa, control), 2) osteochondral pathology with intact RC, 3) partial supraspinatus (SSP) tendon tear, or 4) full-thickness SSP tear were investigated histologically and on gene expression level. Result Bursae from SSP tears differed from non-tendon pathologies by exhibiting increased chondral metaplasia and TGFβ1 expression. MMP1 was not expressed in healthy bursa controls, but strongly increased with full-thickness SSP tears. Additionally, the expression of the inflammatory mediators IL1β, IL6, and COX2 increased with the extent of SSP tear as shown by correlation analysis. In contrast, increased angiogenesis and nerve fibers as well as significantly upregulated IL6 and COX2 expression were features of bursae from patients with osteochondral pathology. Using immunohistochemistry, CD45+ leukocytes were observed in all examined groups, which were identified in particular as CD68+ monocytes/macrophages. Conclusion In summary, besides the strong increase in MMP1 expression with SSP tear, molecular changes were minor between the investigated groups. However, expression of pro-inflammatory cytokines correlated with the severity of the SSP tear. Most pronounced tissue alterations occurred for the osteochondral pathology and full-thickness SSP tear group, which demonstrates that the bursal reaction is not exclusively dependent on the occurrence of an SSP tear rather than longstanding degenerative changes. The present bursa characterization contributes to the understanding of specific tissue alterations related to RC tears or non-tendon shoulder pathologies. This pilot study provides the basis for future studies elucidating the role of the subacromial bursa in the development or healing of shoulder pathologies.
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Farfaras S, Roshani L, Mulder J, Mitsios N, Hallström EK, Kartus JT. Increased levels of inflammatory markers in the subscapularis tendon and joint capsule in patients with subacromial impingement. Knee Surg Sports Traumatol Arthrosc 2021; 29:2228-2236. [PMID: 32356046 PMCID: PMC8225532 DOI: 10.1007/s00167-020-05992-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/07/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To analyze biopsy samples from the subscapularis tendon and from the joint capsule from male patients with subacromial impingement syndrome and compare them with samples from male patients with post-traumatic recurrent shoulder instability, to detect increased inflammatory activity that might be present inside the humeroscapular joint. METHODS Twenty male patients scheduled for surgery for either subacromial decompression or Bankart reconstruction were included. Four biopsies from each patient were obtained during surgery from the capsule and the subscapularis tendon. Each specimen was analyzed for TNF-α, IL-6, CD-3 and CD-72. Multiplex fluorescence immunohistochemistry was performed on histological samples from the capsule and tendon to demonstrate the level of inflammatory markers. Fluorescence microscope images were acquired using an automated scanning system. On each slide, the number of pixels was registered and used in the analyses. RESULTS The subacromial impingement syndrome group comprised eight patients, median age 53 (45-74) years, while the instability group 12, median age 27 (22-48) years (p < 0.00001). The amount of IL-6 and TNF-α was significantly higher in the subscapularis tendon of the patients with subacromial impingement syndrome compared with instability patients (p = 0.0015 and p = 0.0008 respectively). In the capsular samples, significantly higher amount of TNF-α and CD-72 was found in patients with subacromial impingement syndrome compared with instability patients (p < 0.0001 for both). On the other hand, the amount of CD-3 was significantly higher in the instability group (p = 0.0013). CONCLUSIONS This study provides evidence that an extended inflammatory process is present, not only in the subacromial bursa but also in the glenohumeral joint in patients with subacromial impingement syndrome. LEVEL OF EVIDENCE Level III. CLINICAL RELEVANCE To develop a treatment targeted towards intra-articular inflammatory cytokines appears appealing.
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Affiliation(s)
- Stefanos Farfaras
- Department of Research and Development, NU-Hospital Group Trollhättan/Uddevalla, 451 80, Uddevalla, Sweden. .,Department of Orthopedics, Institute of Clinical Science, Sahlgrenska Academy Gothenburg University, Gothenburg, Sweden.
| | - Leyla Roshani
- Department of Research and Development, NU-Hospital Group Trollhättan/Uddevalla, 451 80 Uddevalla, Sweden
| | - Jan Mulder
- Department of Neurosciences, Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden
| | - Nicholas Mitsios
- Department of Neurosciences, Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden
| | - Erling K. Hallström
- Department of Research and Development, NU-Hospital Group Trollhättan/Uddevalla, 451 80 Uddevalla, Sweden ,Department of Orthopedics, NU-Hospital Group Trollhättan/Uddevalla, Uddevalla, Sweden
| | - Jüri-Toomas Kartus
- Department of Research and Development, NU-Hospital Group Trollhättan/Uddevalla, 451 80 Uddevalla, Sweden ,Department of Orthopedics, NU-Hospital Group Trollhättan/Uddevalla, Uddevalla, Sweden ,Department of Orthopedics, Institute of Clinical Science, Sahlgrenska Academy Gothenburg University, Gothenburg, Sweden
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13
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Guan J, Geng WQ, Li Y, Liu GY, Ding LB, Liu YJ, Xue W, Wang H, Zheng XF. Decreased Synovial Fluid Biomarkers Levels Are Associated with Rehabilitation of Function and Pain in Rotator Cuff Tear Patients Following Electroacupuncture Therapy. Med Sci Monit 2020; 26:e923240. [PMID: 32915775 PMCID: PMC7507797 DOI: 10.12659/msm.923240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background The aim of this study was to assess inflammatory cytokines levels in synovial fluid (SF) before and after electroacupuncture (EA) treatment and to explore whether these biomarkers are associated with function of rotator cuff tear (RCT) patients. Material/Methods We recruited 54 patients with RCT and separated them into an EA group and a control group. The SF biomarker levels were detected at baseline and at 6-week and 6-month follow-up. The symptomatic severity was evaluated by visual analog scale (VAS), Constant-Murley score, and American Shoulder and Elbow Surgeons score (ASES). We also investigated the correlation between symptomatic severity and biomarker levels in SF of the shoulder joint. Results The reductions in VAS and improved functional score (ASES and Constant-Murley score) were significantly different between the 2 groups, and SF biomarker concentrations were significantly lower in the EA group. IL-1β levels were significantly negatively correlated with Constant-Murley score (r=−0.73, P=0.04) and ASES score (r=−0.59, P<0.001) and positively correlated with VAS scores (r=0.81, P=0.004). IL-6 levels were significantly negatively correlated with Constant-Murley score (r=−0.67, P=0.03) and positively correlated with VAS score (r=0.7, P=0.01). MMP-1 levels were significantly negatively correlated with ASES score (r=−0.57, P<0.001). Conclusions The biomarkers in SF were directly associated with shoulder pain and shoulder function in rotator cuff tear. EA, as a safe and effective conservative therapy, obviously decreased the level of inflammatory cytokines in RCT patients, accompanied by a reduction in shoulder pain and improved function.
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Affiliation(s)
- Jian Guan
- Department of Orthopedic Surgery, Third Hospital of Shijiazhuang, Shijiazhuang, Hebei, China (mainland)
| | - Wei-Qiang Geng
- Department of Orthopedic Surgery, No. 980 Hospital, Joint Logistics Support Force People's Liberation Army (PLA), Handan Campus of Bethune International Hospital, Handan, Hebei, China (mainland)
| | - Yao Li
- Department of Orthopedic Surgery, Third Hospital of Shijiazhuang, Shijiazhuang, Hebei, China (mainland)
| | - Guang-Yuan Liu
- Department of Orthopedic Surgery, Third Hospital of Shijiazhuang, Shijiazhuang, Hebei, China (mainland)
| | - Luo-Bin Ding
- Department of Orthopedic Surgery, Third Hospital of Shijiazhuang, Shijiazhuang, Hebei, China (mainland)
| | - You-Jie Liu
- Department of Orthopedic Surgery and Sports Medicine Center, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China (mainland)
| | - Wei Xue
- Department of Orthopedics, Handan Central Hospital, Handan, Hebei, China (mainland)
| | - Huajun Wang
- Department of Orthopedic Surgery and Sports Medicine Center, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China (mainland)
| | - Xiao-Fei Zheng
- Department of Orthopedic Surgery and Sports Medicine Center, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China (mainland)
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14
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Stone M, Jamgochian G, Thakar O, Patel MS, Abboud JA. Synovial Fluid Volume at the Time of Arthroscopic Rotator Cuff Repair Correlates With Tear Size. Cureus 2020; 12:e9224. [PMID: 32821573 PMCID: PMC7430535 DOI: 10.7759/cureus.9224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Inflammatory biomarkers are increased in the synovium and tendon of rotator cuff tears. Several studies demonstrate an associated increase in these markers and size of the tear, with implications of chondral destruction leading to rotator cuff tear arthropathy and glenohumeral arthritis. Methods This is a prospective study of 105 patients undergoing arthroscopic rotator cuff repair in which intra-articular synovial fluid was aspirated just prior to arthroscopy. Adult patients with a partial or full-thickness rotator cuff tear undergoing arthroscopic repair were included, and those with inflammatory arthritis, active infection, open cuff repair, intraoperative findings of osteoarthritis, or those undergoing revision cuff repair were excluded. Results The average patient age was 58 years (range 33-74 years), with 59 (56.2%) males. The mean aspirate volume of partial tears was 0.76 ± 0.43 mL, small tears 1.46 ± 1.88 mL, medium tears 3.04 ± 2.21 mL, and large tears 6.60 ± 3.23 mL. Full-thickness versus partial tears had significantly more synovial fluid (3.64 vs. 0.76 mL, respectively, p < 0.0001). An aspiration volume of 1.5 mL or greater resulted in 91.3% specificity and 96.8% positive predictive value for a full-thickness tear. Smoking (p = 0.017), tear size (p < 0.0001), and tears of the infraspinatus (p = 0.048) were significantly correlated with synovial fluid volume. Age, body mass index, chronicity of tear, sex, subscapularis involvement, supraspinatus involvement, and teres minor involvement had no association to synovial fluid volume. Conclusion Preoperative aspiration of the glenohumeral joint to identify the volume of synovial fluid can aid to identify full-thickness rotator cuff tears, and increased fluid volume should alert the clinician of a large tear.
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Affiliation(s)
- Michael Stone
- Shoulder and Elbow Surgery, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Grant Jamgochian
- Shoulder and Elbow Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, USA
| | - Ocean Thakar
- Orthopaedics, MedStar Union Memorial Hospital, Baltimore, USA
| | - Manan S Patel
- Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Joseph A Abboud
- Shoulder and Elbow Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, USA
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15
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Plachel F, Heuberer P, Gehwolf R, Frank J, Tempfer H, Lehner C, Weissenbacher N, Wagner A, Weigl M, Moroder P, Hackl M, Traweger A. MicroRNA Profiling Reveals Distinct Signatures in Degenerative Rotator Cuff Pathologies. J Orthop Res 2020; 38:202-211. [PMID: 31520478 PMCID: PMC6973295 DOI: 10.1002/jor.24473] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 09/03/2019] [Indexed: 02/04/2023]
Abstract
MicroRNAs (miRNAs) have emerged as key regulators orchestrating a wide range of inflammatory and fibrotic diseases. However, the role of miRNAs in degenerative shoulder joint disorders is poorly understood. The aim of this explorative case-control study was to identify pathology-related, circulating miRNAs in patients with chronic rotator cuff tendinopathy and degenerative rotator cuff tears (RCT). In 2017, 15 patients were prospectively enrolled and assigned to three groups based on the diagnosed pathology: (i) no shoulder pathology, (ii) chronic rotator cuff tendinopathy, and (iii) degenerative RCTs. In total, 14 patients were included. Venous blood samples ("liquid biopsies") were collected from each patient and serum levels of 187 miRNAs were determined. Subsequently, the change in expression of nine candidate miRNAs was verified in tendon biopsy samples, collected from patients who underwent arthroscopic shoulder surgery between 2015 and 2018. Overall, we identified several miRNAs to be progressively deregulated in sera from patients with either chronic rotator cuff tendinopathy or degenerative RCTs. Importantly, for the several of these miRNAs candidates repression was also evident in tendon biopsies harvested from patients who were treated for a supraspinatus tendon tear. As similar expression profiles were determined for tendon samples, the newly identified systemic miRNA signature has potential as novel diagnostic or prognostic biomarkers for degenerative rotator cuff pathologies. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. Inc. J Orthop Res 38:202-211, 2020.
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Affiliation(s)
- Fabian Plachel
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration, Center SalzburgParacelsus Medical UniversitySalzburgAustria,Center for Musculoskeletal Surgery, Campus VirchowCharité UniversitaetsmedizinBerlinGermany
| | | | - Renate Gehwolf
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration, Center SalzburgParacelsus Medical UniversitySalzburgAustria,Austrian Cluster for Tissue RegenerationViennaAustria
| | - Julia Frank
- Vienna Shoulder & Sports ClinicViennaAustria
| | - Herbert Tempfer
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration, Center SalzburgParacelsus Medical UniversitySalzburgAustria,Austrian Cluster for Tissue RegenerationViennaAustria
| | - Christine Lehner
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration, Center SalzburgParacelsus Medical UniversitySalzburgAustria,Austrian Cluster for Tissue RegenerationViennaAustria
| | - Nadja Weissenbacher
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration, Center SalzburgParacelsus Medical UniversitySalzburgAustria,Austrian Cluster for Tissue RegenerationViennaAustria
| | - Andrea Wagner
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration, Center SalzburgParacelsus Medical UniversitySalzburgAustria,Austrian Cluster for Tissue RegenerationViennaAustria
| | | | - Philipp Moroder
- Center for Musculoskeletal Surgery, Campus VirchowCharité UniversitaetsmedizinBerlinGermany
| | | | - Andreas Traweger
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration, Center SalzburgParacelsus Medical UniversitySalzburgAustria,Austrian Cluster for Tissue RegenerationViennaAustria
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