Ultrasonographic clues for acuity/chronicity of rotator cuff tear

Quantitative Analysis of Contrast-Enhanced Ultrasound That Can Be Used to Evaluate Angiogenesis during Patellar Tendon Healing in Rats

Objective

To investigate the efficacy of contrast-enhanced ultrasound (CEUS) in quantitatively evaluating angiogenesis during patellar tendon healing in rats.

Methods

A total of 40 Sprague-Dawley rats were used in this study. The patellar tendons of 30 rats (60 limbs) that underwent incision and suture were treated as the operation group and monitored after 7, 14, and 28 days. The normal patellar tendons of 10 rats (20 limbs) were treated as the control group and monitored on day 0. The ultrasound examination was used to evaluate the structure and blood perfusion of the patellar tendon. Immunohistochemistry was used to assess angiogenesis, and the biomechanical test was used to verify functional recovery of the patellar tendon.

Results

The tendons in the operation group were significantly thickened compared with those in the control group (p < 0.01). The peak intensity (PI) in CEUS of the tendons showed a clear difference at each time point after the surgery (p < 0.01). PI increased in the operation group with a maximum on day 7, and then gradually decreased until day 28 when PI was close to the basic intensity (BI) in the control group (p > 0.05). It was consistent with the change of the CD31-positive staining areas representing angiogenesis of the injured patellar tendons. The PI was positively correlated with the CD31-positive staining area fraction (R = 0.849, p < 0.001). The failure load and tensile strength of the repaired patellar tendons in the operation group increased over time. The PI showed negative correlations with the failure load (R = -0.787, p < 0.001) and tensile strength (R = -0.714, p < 0.001).

Conclusion

The PI in CEUS could quantitatively reflect the time-dependent change in the blood supply of the healing site, and the PI correlated with histologic and biomechanical properties of the healing tendon. Quantitative analysis of contrast-enhanced ultrasound could be a useful method to evaluate angiogenesis in healing tendons.

Definition of the terms "acute" and "traumatic" in rotator cuff injuries: a systematic review and call for standardization in nomenclature

BACKGROUND

Although of high relevance for clinical decision making, there exists no consensus throughout the literature of the terms "acute" and "traumatic" used in the classification of rotator cuff tears. With differing definitions, the comparability of outcome studies may be limited. The aim was to provide a detailed systematic review of the definitions used in the literature and present a suggestion for a standardization in nomenclature based on the findings.

METHODS

Four different internet databases were searched in February 2020 using the terms ("acute" OR "traumatic" OR "trauma" OR "athlete" OR "young") AND ("rotator cuff tears" OR "rotator cuff tear" OR "rotator cuff" OR "rotator cuff rupture" OR "supraspinatus" OR "infraspinatus" OR "subscapularis" OR "teres minor"). Prospective, retrospective, cohort and case-control studies as well as case series were included. Systematic reviews, cadaveric or laboratory studies and studies on non-traumatic or non-acute rotator cuff tears were excluded.

RESULTS

The literature search conducted 10,349 articles of which 10,151 were excluded based on the title, 119 based on the abstract and 33 based on the manuscript. A total of 46 studies were finally included for review and subsequently analyzed. Overall, there exists no consensus neither on the term "acute" nor on "traumatic" in the context of rotator cuff tears in the literature. The time span for acute injuries ranged between 2 weeks and 6 months. For traumatic injuries, only 20% of the selected studies described a specific and adequate injury mechanism in combination with adequate imaging.

CONCLUSION

The term "acute" should be reserved for RCT showing muscle edema, wavelike appearance of the central part of the torn tendon and joint effusion, which typically requires adequate imaging within 2 weeks from trauma. Repair of acute tears should occur within 8 weeks from trauma to benefit from possibly superior biological healing capacities. The term "traumatic" should be used for a sudden onset of symptoms in a previously asymptomatic patient, triggered by an adequate trauma, e.g., a fall on the retroverted arm with an axial cranioventral force or a traumatic shoulder dislocation.

Back to the roots of rheumatology - Imaging of regional pain syndromes

Musculoskeletal regional pain syndromes (RPS) often lead to patient referrals in general and rheumatological practice. Detailed history taking and clinical examination can, in most cases, reveal the cause for pain and direct the subsequent management of the conditions. Yet, when in doubt, imaging methods, such as ultrasound (US) may support the clinical assessment. This paper reviews the underlying pathologies of some of the most frequently encountered RPS and the role of musculoskeletal US imaging for their diagnosis and treatment. If available, data on diagnostic accuracy and comparisons with gold standards are reported. The article stresses the importance of anatomical and sonoanatomical knowledge for the proper interpretation of the US images, points out the advantages and disadvantages of this imaging tool, and suggests the future research agenda.

[Ultrasound findings in chronic subacromal pain syndrome]

OBJECTIVE

Subacromial pain syndrome is a clinical picture characterised by pain located around the acromion triggered or exacerbated by shoulder movements. Ultrasound is a suitable imaging technique to evaluate the soft tissues occupying the subacromial space. The aim of this study was to describe the ultrasound findings in patients diagnosed with chronic subacromial pain syndrome by age, sex, and time since onset.

MATERIAL AND METHODS

We conducted a retrospective study of patients diagnosed with chronic SDS who underwent shoulder ultrasound. The variables studied were age, sex, affected side, time since onset, sonographic findings and ultrasound diagnosis. A descriptive study of the variables and statistical inference was performed with the chi-square test.

RESULTS

A total of 253 clinical histories of patients who underwent shoulder ultrasound were reviewed. Of these, 100 were selected who met the pre-established criteria. Involvement was bilateral in 5 of them and consequently the total number of ultrasound scans reviewed was 105. Differences were found between ultrasound finding by age, but not by sex or time since onset.

CONCLUSIONS

The findings of this study indicate that there is good clinical-radiological correlation between subacromial pain syndrome and ultrasound findings. The structure most frequently involved in the origin of the pain was the supraspinatus tendon. Differences were found by age but not by sex or the time since onset.