Article

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: 3.61). 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.

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    ABSTRACT: Purpose: Not much is known about the obvious relationship between posteroinferior rotator cuff tear and biceps lesion. The purpose of this study is to analyze the effect of posteroinferior rotator cuff tear on a biceps lesions by comparing the rotator cuff tear and biceps lesions with the number of cuff tears and the degree of degeneration of the rotator cuff. Materials and Methods: 65 patients who underwent surgery for a posteroinferior rotator cuff tear from 2002 to 2009 were included as subjects. The study determined the factors (the number of cuff tears and the degree of degeneration as assessed by MRI) that affected biceps lesions and the kinematic stability of the rotator cuff. Results: Biceps lesion was noted 11 patients among the 51 patients with supraspinatus tendon tears and in 8 patients among the 14 patients with supraspinatus, infraspinatus or teres minor tendon tears, and there was a statistically significant difference between those two groups (p=0.0095). The number of cuff tears was proportional to biceps lesion with statistical significance (p=0.0095). Among the biceps lesions, SLAP II lesion showed a statistically different distribution according to the number of cuff tears (p=0.0073). The degeneration factors (Goutallier's classification and the tangent sign) had no correlations with biceps lesion. Conclusion: Posterosuperior cuff tear may affect biceps lesion. Especially, the number of cuff tears has a close relationship, but the degenerative indicators have no relationship with biceps lesion.
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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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