Rotator cuff degeneration: etiology and pathogenesis.

The Hospital for Special Surgery, 535 East 70th Street, York, NY 10021, USA.
The American Journal of Sports Medicine (Impact Factor: 4.7). 06/2008; 36(5):987-93. DOI: 10.1177/0363546508317344
Source: PubMed

ABSTRACT By virtue of its anatomy and function, the rotator cuff is vulnerable to considerable morbidity, often necessitating surgical intervention. How we intervene is governed by our understanding of the pathological mechanisms in cuff disease. These factors can be divided into those extrinsic to the rotator cuff (impingement, demographic factors) and those intrinsic to the cuff (age-related degeneration, hypovascularity, inflammation, and oxidative stress, among others). In an era where biologic interventions are increasingly being investigated, our understanding of these mechanisms is likely to become more important in designing effective new interventions. Here we present a literature review summarizing our current understanding of the pathophysiological mechanisms underlying rotator cuff degeneration.


Available from: Shane J Nho, Mar 29, 2015
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    ABSTRACT: Rotator cuff tears occur in almost three percent of all industrial accidents in Belgium. There are two treatment options for this type of injury: the non-surgical or 'conservative' option and the considerably more expensive surgical option. As the total cost associated with the treatment of rotator cuff tears has, over the past ten years, risen considerably in Belgium, we tried to identify variables that are related to an increased risk for need of such surgical treatment. The objective of this study is to evaluate the use of different treatment options and their economic impact following rotator cuff tearing resulting from an occupational accident in the Belgian context. Patient age and rupture size were interrelated and both significantly associated with need for surgical treatment and prolonged temporarily and even permanent disability with increasing social and medical costs. Occupation type, although itself a risk factor for the development of rotator cuff tears, was not significantly associated with increased need for surgical treatment.
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    ABSTRACT: Quantitative MRI T2 mapping is a non-invasive imaging technique sensitive to biochemical changes, but no studies have evaluated T2 mapping in pathologic rotator cuff tendons. It was sought to evaluate the efficacy of T2 mapping in detecting differences in the supraspinatus tendon (SST) among patients with tendinosis, partial tears and minimally retracted full-thickness tears, relative to asymptomatic volunteers. The pathologic cohort consisted of two arthroscopically verified groups: tendinosis and a tear group of partial tears or minimally retracted full-thickness tears, and was compared to an asymptomatic cohort with no prior history of shoulder pathology. The SST was manually segmented from the footprint to the medial humeral head in the coronal and sagittal planes and divided into six clinically relevant subregions. Mean T2 values and inter- and intra-rater reliability were assessed. In the anterolateral subregion, the tear group exhibited significantly higher mean T2 values (43.9 ± 12.7 ms) than the tendinosis (34.9 ± 3.9 ms; p = 0.006) and asymptomatic (33.6 ± 5.3 ms; p = 0.015) groups. In the posterolateral subregion, the tear group had higher mean T2 values (45.2 ± 13.7) than the asymptomatic group (34.7 ± 6.7; p = 0.012). Inter- and intra-rater reliability was mostly excellent (ICC > 0.75). T2 mapping is an accurate non-invasive method to identify quantitatively early rotator cuff pathology. The lateral region in the coronal plane in particular may differentiate partial and small minimally retracted full-thickness tears from tendinosis and asymptomatic tendons. Understanding and being able to measure quantitatively the process of tendon degeneration and subsequent tearing may help clinicians to better predict at-risk groups and to stratify treatment options. LEVEL OF EVIDENCE: III.