Thursday, February 4, 2016

Rotator cuff tears - does inflammation account for the pain?

Association of synovial inflammation and inflammatory mediators with glenohumeral rotator cuff pathology

These authors point out that chronic inflammation has recently been recognized as a source of joint pain and dysfunction in those with pathologies previously considered purely degenerative. They hypothesized that patients with full-thickness rotator cuff tears would have greater synovial inflammation compared with those without rotator cuff tear pathology, with gene expression relating to histologic findings.

Synovial sampling was obtained from a common site within the rotator interval after anterior portal establishment in 19 patients with full thickness rotator cuff tears (RTC group) and in 11 patients without rotator cuff pathology (control group).

The synovitis score was significantly increased in the RTC group compared with controls. Immunofluorescence demonstrated significantly increased staining for CD31, CD45, and CD68 in the RTC vs control group. CD45+/68– cells were found perivascularly, with CD45+/68+ cells toward the joint lining edge of the synovium. Levels of matrix metalloproteinase-3 (MMP-3) and interleukin-6 were significantly increased in the RTC group, with a positive correlation between the synovitis score and MMP-3 expression. No correlation was found between the synovitis score and tear size or Goutallier classification nor between MMP-3 levels and AP tear size, amount of retraction, or Goutallier classification for those with cuff tears.

The authors concluded that shoulders with full-thickness rotator cuff tears had greater levels of synovial inflammation, angiogenesis, and MMP-3 upregulation compared with controls. Gene expression of MMP-3 correlated with the degree of synovitis.

Comment: These results indicate an association between synovial inflammation and cuff tears; they do not indicate whether synovial inflammation contributes to the development of cuff tears or vice versa. Nevertheless, this association may help understand the effectiveness of anti-inflammatory medications in the management of symptoms from rotator cuff pathology. It may also help explain the mechanism by which the smooth and move procedure (which includes the excision of inflammatory tissue in the humeroscapular motion interface) leads to improved comfort and function of shoulders with cuff tears, even though the tear itself is irreparable.


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