No Difference in Outcome Between Articular-Sided and Bursal-Sided Tears: Comparative Study With Minimum 2-Year Follow-Up of Arthroscopic Repairs in 104 Patients in a Single-Surgeon Series.

PURPOSE: To evaluate and compare the functional outcomes after arthroscopic repair of bursal-sided versus articular-sided partial-thickness rotator cuff tears. METHODS: We conducted a retrospective analysis of patients who had undergone arthroscopic tear completion and subsequent repair of symptomatic partial-thickness rotator cuff tears in a single institution from 2010 to 2015. Range of motion (ROM) (forward flexion and abduction), the pain score as measured on the Numeric Pain Rating Scale, and outcome scores (Constant-Murley score, University of California, Los Angeles shoulder score, and Oxford Shoulder Score) were calculated preoperatively and at 1 year and 2 years postoperatively. The delta difference was calculated for each outcome parameter at the respective follow-up points as the difference from the preoperative baseline score. RESULTS: A total of 104 patients were included. All tears involved the supraspinatus tendon and did not exceed 2 cm. Of the patients, 65 had an articular-sided tear (AST) whereas 39 had a bursal-sided tear (BST). The mean age of the patients was 53.4 years in the AST group and 55.8 years in the BST group. The AST and BST groups did not differ preoperatively in terms of age, sex, and the measured outcome parameters. Postoperatively, the patients in both groups achieved statistically significant improvement in pain relief and functional outcomes at 2 years. No statistically significant difference was observed between the 2 groups in terms of the delta-difference outcomes in ROM in forward flexion (P = .781) or abduction (P = .348), pain score (P = .187), Constant-Murley score (P = .186), University of California, Los Angeles shoulder score (P = .911), and Oxford Shoulder Score (P = .186) at 2 years. CONCLUSIONS: Partial-thickness rotator cuff tears treated with arthroscopic tear completion and subsequent repair achieved good outcomes in terms of ROM, functional outcomes, and pain relief at 2 years. There was no difference in outcomes regardless of whether the location of the tear was articular sided or bursal sided. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Bursal lipohematoma: a CT sign of full thickness rotator cuff tear in patients with proximal humerus fractures.

PURPOSE: The main purpose of the study is to determine if the presence of a particular computed tomography (CT) imaging finding, a bursal lipohematoma, portends the presence of a concomitant rotator cuff tear (RCT) in patients with proximal humerus fractures by reviewing previous CTs. METHODS: Three hundred eighty-six CT scans were retrospectively reviewed by two board-certified radiologists to determine the presence of a proximal humerus fracture and to assess for the presence of a subacromial/subdeltoid or subcoracoid bursal hematoma. The medical record including operative documentation was then examined in the patients with proximal humerus fractures, with or without a concomitant bursal lipohematoma. RESULTS: Of the surgically managed patients, four had an intraoperative diagnosis of RCT. The preoperative CT scans of all of these patients demonstrated a bursal lipohematoma. Additionally, a non-surgically managed patient with a subacromial/subdeltoid bursal lipohematoma on CT scan was found to have a RCT on subsequent MRI. Of note, a rotator cuff tear was not documented in operative reports of patients with CT scans that were not found to contain a bursal lipohematoma. CONCLUSIONS: Bursal lipohematoma is a potentially useful preoperative CT sign of full thickness rotator cuff tear in patients with proximal humerus fractures, providing the clinician with more information in the optimization of the management approach.

IL-1ß mediates NGF and COX-2 expression through transforming growth factor-activating kinase 1 in subacromial bursa cells derived from rotator cuff tear patients.

BACKGROUND: Increased interleukin (IL)-1ß expression in the subacromial bursa (SAB) is associated with severe pain in rotator cuff tears (RCTs). Additionally, transforming growth factor (TGF)-ß-activated kinase 1 (TAK1) is essential for cytokine-mediated cascades. TAK1 also regulates the expression of pain-associated molecules such as cycloxygenase-2 (COX-2) and nerve growth factor (NGF) in synovial fibroblasts; however, this regulation in the SAB is not fully understood. METHODS: SAB samples were harvested from 18 subjects with RCTs. The expression and localization of NGF and COX-2 was determined using polymerase chain reaction (PCR) analysis and immunohistochemistry. Regulation of COX-2 and NGF by IL-1ß in subacromial bursa cells (SABCs) was investigated by culturing and stimulating SABCs with vehicle control (culture medium), 50 ng/ml recombinant human IL-1ß (rhIL1-ß), 50 ng/ml rhIL-1ß and 10 µM celecoxib (COX-2 inhibitor), or 10 µM prostaglandin E2 (PGE2) for 24 h. The effects of TAK1 inhibition on rhIL-1ß stimulation were determined by culturing and treating SABCs with control, 50 ng/ml rhIL-1ß, or 50 ng/ml rhIL-1ß and 10 µM (5Z)-7-oxozeaenol (TAK1 inhibitor) for 24 h. NGF and COX-2 mRNA expression was monitored using quantitative PCR. RESULTS: COX-2 and NGF mRNA expression was observed in all SAB specimens. Immunohistochemical analysis showed that COX-2-positive cells were in the lining and sublining layers. NGF-positive cells were observed in the sublining layer. rhIL-1ß treatment significantly increased NGF and COX-2 mRNA levels compared with control cells. The COX-2 inhibitor did not suppress rhIL-1ß-induced NGF expression, and PGE2 stimulation did not alter NGF mRNA expression. In contrast, the TAK1 inhibitor significantly reduced rhIL-1ß-stimulated COX-2 and NGF mRNA expression. CONCLUSION: IL-1ß regulates the expression of NGF and COX-2, pain-related molecules in the SAB, through TAK1. Therefore, TAK1 may be one potential therapeutic target for reducing pain in patients with RCTs.

Arthroscopic in Situ Repair of Partial Bursal Rotator Cuff Tears Without Acromioplasty.

PURPOSE: To evaluate functional outcomes and complications in a consecutive group of patients with partial bursal rotator cuff tears (PBRCTs) treated with insitu repair without acromioplasty. METHODS: Seventy-four patients who had undergone an arthroscopic single row in situ repair for bursal-sided rotator cuff tears were evaluated. Clinical assessment consisted of glenohumeral range of motion measurement, the American Shoulder and Elbow Surgeons score, and the University of California at Los Angeles score. Pain was recorded using a visual analog scale. Postoperative complications were also assessed. RESULTS: Mean age was 55.2 years (±6.3) with a minimum of 2-year follow-up. After arthroscopic repair, all active range of motion parameters improved significantly (P < .0001). The American Shoulder and Elbow Surgeons scores improved from 42.5 to 86.1; the University of California at Los Angeles scores improved from 15.8 to 31.4, and the visual analog scale scores improved from 6.6 to 0.7 (P < .0001). Only 3 patients developed a postoperative adhesive capsulitis that responded to physical therapy. CONCLUSIONS: In the midterm follow-up (42 months), arthroscopic in situ repair of PBRCTs without acromioplasty is a reliable procedure that produces significant functional improvements and pain relief. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Frequency of Penetration of the Digital Flexor Tendon Sheath and Distal Interphalangeal Joint Using a Direct Endoscopic Approach to the Navicular Bursa in Horses.

OBJECTIVE: To evaluate the frequency of inadvertent penetration of the digital flexor tendon sheath (DFTS) and/or distal interphalangeal joint (DIPJ) when using a direct endoscopic approach to the navicular bursa, and to evaluate an alternate direct approach to the navicular bursa. STUDY DESIGN: Cadaveric study. SAMPLE POPULATION: Equine cadaver limbs (n = 40 for direct; n = 12 for alternate approach). METHODS: Four surgeons performed the direct endoscopic approach to the navicular bursa on 10 limbs each. Frequencies of inadvertent synovial penetration and iatrogenic damage were compared between surgeons. Use of an alternate direct approach, adopting a straight parasagittal trajectory, was evaluated by 2 surgeons. RESULTS: Inadvertent synovial penetration occurred in 45% of limbs (DFTS 37.5%; DIPJ 17.5%; and both structures 10%). Successful bursa entry was achieved on the first attempt in 45% of limbs. Significant variation in frequency of inadvertent synovial penetration was observed between surgeons (range 10-80%). Inadvertent synovial penetration did not occur when using the alternate direct technique. Iatrogenic damage to navicular bone fibrocartilage and/or deep digital flexor tendon occurred in 55% of limbs using the direct endoscopic approach and in 0% of limbs using the alternate direct approach. CONCLUSION: Because of the considerable risk of inadvertent penetration of the DFTS and/or the DIPJ when making a direct endoscopic approach to the navicular bursa, it is advisable to investigate for inadvertent penetration when treating navicular bursa sepsis using a direct approach. The alternate direct technique may reduce the risk of inadvertent penetration; however, the view within the bursa may be restricted.

Physical tests for shoulder impingements and local lesions of bursa, tendon or labrum that may accompany impingement.

BACKGROUND: Impingement is a common cause of shoulder pain. Impingement mechanisms may occur subacromially (under the coraco-acromial arch) or internally (within the shoulder joint), and a number of secondary pathologies may be associated. These include subacromial-subdeltoid bursitis (inflammation of the subacromial portion of the bursa, the subdeltoid portion, or both), tendinopathy or tears affecting the rotator cuff or the long head of biceps tendon, and glenoid labral damage. Accurate diagnosis based on physical tests would facilitate early optimisation of the clinical management approach. Most people with shoulder pain are diagnosed and managed in the primary care setting. OBJECTIVES: To evaluate the diagnostic accuracy of physical tests for shoulder impingements (subacromial or internal) or local lesions of bursa, rotator cuff or labrum that may accompany impingement, in people whose symptoms and/or history suggest any of these disorders. SEARCH METHODS: We searched electronic databases for primary studies in two stages. In the first stage, we searched MEDLINE, EMBASE, CINAHL, AMED and DARE (all from inception to November 2005). In the second stage, we searched MEDLINE, EMBASE and AMED (2005 to 15 February 2010). Searches were delimited to articles written in English. SELECTION CRITERIA: We considered for inclusion diagnostic test accuracy studies that directly compared the accuracy of one or more physical index tests for shoulder impingement against a reference test in any clinical setting. We considered diagnostic test accuracy studies with cross-sectional or cohort designs (retrospective or prospective), case-control studies and randomised controlled trials. DATA COLLECTION AND ANALYSIS: Two pairs of review authors independently performed study selection, assessed the study quality using QUADAS, and extracted data onto a purpose-designed form, noting patient characteristics (including care setting), study design, index tests and reference standard, and the diagnostic 2 x 2 table. We presented information on sensitivities and specificities with 95% confidence intervals (95% CI) for the index tests. Meta-analysis was not performed. MAIN RESULTS: We included 33 studies involving 4002 shoulders in 3852 patients. Although 28 studies were prospective, study quality was still generally poor. Mainly reflecting the use of surgery as a reference test in most studies, all but two studies were judged as not meeting the criteria for having a representative spectrum of patients. However, even these two studies only partly recruited from primary care.The target conditions assessed in the 33 studies were grouped under five main categories: subacromial or internal impingement, rotator cuff tendinopathy or tears, long head of biceps tendinopathy or tears, glenoid labral lesions and multiple undifferentiated target conditions. The majority of studies used arthroscopic surgery as the reference standard. Eight studies utilised reference standards which were potentially applicable to primary care (local anaesthesia, one study; ultrasound, three studies) or the hospital outpatient setting (magnetic resonance imaging, four studies). One study used a variety of reference standards, some applicable to primary care or the hospital outpatient setting. In two of these studies the reference standard used was acceptable for identifying the target condition, but in six it was only partially so. The studies evaluated numerous standard, modified, or combination index tests and 14 novel index tests. There were 170 target condition/index test combinations, but only six instances of any index test being performed and interpreted similarly in two studies. Only two studies of a modified empty can test for full thickness tear of the rotator cuff, and two studies of a modified anterior slide test for type II superior labrum anterior to posterior (SLAP) lesions, were clinically homogenous. Due to the limited number of studies, meta-analyses were considered inappropriate. Sensitivity and specificity estimates from each study are presented on forest plots for the 170 target condition/index test combinations grouped according to target condition. AUTHORS' CONCLUSIONS: There is insufficient evidence upon which to base selection of physical tests for shoulder impingements, and local lesions of bursa, tendon or labrum that may accompany impingement, in primary care. The large body of literature revealed extreme diversity in the performance and interpretation of tests, which hinders synthesis of the evidence and/or clinical applicability.

Septic inflammation of the bicipital bursa: clinical, imaging, and surgical findings in nine horses.

OBJECTIVE: To describe the etiologies, clinicopathologic findings, diagnostic modalities employed, treatments, and outcome associated with cases of septic bicipital bursitis. ANIMALS: 9 horses. CLINICAL PRESENTATION AND PROCEDURES: Medical records of horses diagnosed with septic bicipital bursitis between 2000 and 2021 were reviewed. Horses were included if synoviocentesis of the bicipital bursa revealed a total nucleated cell count of ≥ 20,000 cells/µL with a neutrophil proportion of ≥ 80%, a total protein concentration of ≥ 4.0 g/dL, and/or the presence of bacteria on cytology, or positive culture of the synovial fluid. Information retrieved from medical records included signalment, history, clinicopathologic variables, diagnostic imaging findings, treatment, and outcome. RESULTS: Trauma was the most common inciting cause (n = 6). Synoviocentesis using ultrasonographic guidance was performed in all cases and showed alterations consistent with septic synovitis. Radiography identified pathology in 5 horses, whereas ultrasonography identified pathology in all horses. Treatment consisted of bursoscopy (n = 6) of the bicipital bursa of which 1 was performed under standing sedation, through-and-through needle lavage (3), bursotomy (2), or medical management alone (2). Five (55.6%) horses survived to discharge. Long-term follow-up was available for 3 horses and all were serviceably sound, with 2 in training as pleasure horses and 1 case continuing retirement. CLINICAL RELEVANCE: Ultrasonography was the most informative imaging modality and paramount in obtaining synovial fluid samples for definitive diagnosis of septic bicipital bursitis. Bursoscopy performed under standing sedation is a feasible treatment option. Horses treated for bicipital septic bursitis have a fair prognosis for survival and may return to some level of athletic performance.

Clinical features of partial anterior bursal-sided supraspinatus tendon (PABST) lesions.

BACKGROUND: We characterized partial anterior and bursal supraspinatus tendon (PABST) lesions and compared their clinical features, postoperative functional scores, and healing rate with full-thickness rotator cuff tears (FTRCTs) and small FTRCTs. MATERIALS AND METHODS: There were 31 PABST lesions (6.2%), 392 FTRCTs, and 32 small FTRCTs among 495 shoulders with rotator cuff disorders. The mean patient age was 52.7 years in the PABST group, 60.1 years in the FTRCT group, and 56.9 years in the small FTRCT group. Functional and clinical variables were compared between the groups, and cuff healing was evaluated with computed tomography arthrography or ultrasonography. RESULTS: The mean patient age was statistically lower, the mean symptom duration was shorter, and trauma was more frequent in the PABST group compared with the FTRCT and small FTRCT groups. Coronal acromial spurs were found more frequently in the PABST group than in the FTRCT group. In all groups, range of motion, visual analog scale for pain, and functional scores improved continuously throughout the follow-up. There were 2 unhealed cuffs (10.5%) in the PABST group, 72 (35.6%) in the FTRCT group (P = .146), and 5 (25%) in the small FTRCT group (P = .238). CONCLUSIONS: We characterized PABST lesions that may be overlooked because of their peculiar location in the far anterolateral insertional section of the supraspinatus tendon at the bursal side. PABST lesions usually occur in younger patients, and trauma is frequently associated with acute symptom onset. Surgical treatment was effective for pain reduction and functional improvement.

MR evaluation of synovial injury in shoulder trauma.

The purpose of this study was to determine magnetic resonance imaging (MRI) findings relevant to synovial injury of the shoulder in patients with and without acute shoulder trauma. Three hundred and nine consecutive shoulder MRI studies (185-male, 124-female, 50 ± 15 years old) were retrospectively evaluated for findings suggestive of synovial injury including rupture and/or diverticulum of the joint capsule, bursa, and biceps tendon sheath (BTS), ganglion/synovial cyst, geyser phenomenon, and sequel of previous shoulder dislocation (Hill-Sachs deformity). Patients with one or more of these findings were included in the MR-positive group, whereas the remaining subjects were used as MR negatives. Based on their medical records, patients were also divided into trauma and non-trauma groups, and statistical analysis was performed to evaluate the association between the aforementioned MRI findings and history of shoulder trauma. Fifty-six patients were included in the MR-positive group and 253 in the MR-negative group. In MR-positive group, the incidence of capsular rupture (CR) and subacromial/subdeltoid (SASD) bursal rupture was higher in trauma patients, whereas the incidence of BTS diverticulum and ganglion cyst was higher in subjects without trauma. Significant association was found between the history of acute trauma and CR, SASD bursal rupture, BTS rupture, and Hill-Sachs deformity. In shoulder MR examination, presence of CR and/or SASD bursal rupture is strongly suggestive of acute shoulder trauma. In addition, BTS rupture and Hill-Sachs deformity are more prevalent in patients with acute shoulder trauma. The presence of these features should alert MRI readers to assess for additional trauma-related internal derangements, if a respective history has not been provided.

Endoscopic treatment of prepatellar bursitis.

Operative treatment of prepatellar bursitis is indicated in intractable bursitis. The most common complication of surgical treatment for prepatellar bursitis is skin problems. For traumatic prepatellar bursitis, we propose a protocol of outpatient endoscopic surgery under local anaesthesia. From September 1996 to February 2001, 60 cases of failed nonoperative treatment for prepatellar bursitis were included. The average age was 33.5 ± 11.1 years (range 21-55). The average operation duration was 18 minutes. Two to three mini-arthroscopic portals were used in our series. No sutures or a simple suture was needed for the portals after operation. After follow-up for an average of 36.3 months, all patients are were symptom-free and had regained knee function. None of the population had local tenderness or hypo-aesthesia around their wound. Their radiographic and sonographic examinations showed no recurrence of bursitis. Outpatient arthroscopic bursectomy under local anaesthesia is an effective procedure for the treatment of post-traumatic prepatellar bursitis after failed conservative treatments. Both the cosmetic results and functional results were satisfactory.

[Arthroscopic treatment of bursal-side partial-thickness rotator cuff tears].

OBJECTIVE: To study the surgical techniques and results of arthroscopic treatment of bursal-side partial-thickness rotator cuff tears. METHODS: From June 2002 to December 2007, 57 patients with bursal-side partial-thickness rotator cuff tears underwent arthroscopic treatment. There were 34 male and 15 female patients, the average age was 49.7 years (25 - 71 years). Fifteen left shoulder and 34 right ones were involved. Seven cases were classified as degree I, 6 as II and 36 as III according to Ellman classification. The anterior-posterior and the supraspinatus outlet projection of the X-rays were obtained before surgery. Twenty-nine patients had been received by sonography and 36 patients had undergone MRI examinations. All the patients underwent subacromial bursectomy and acromioplasty, 13 cases underwent cuff debridement, 36 cases underwent cuff repair. Among them, 3 cases were treated by side to side suture of rotator cuff, 26 cases were treated by suture anchor, 7 cases were treated by side to side suture combined with suture anchor. UCLA scoring system was adopted before operation and at the final evaluation. RESULTS: Forty-nine patients had been reviewed at least 2 years after the operation with an average of 48 months (2 to 7 years). The average score was 32.1 ± 3.8 postoperatively, and the mean pain score was 2.9 ± 1.0 vs 8.4 ± 1.7 (P = 0.000) for pre- vs. post-operation, the function score was 5.4 ± 1.2 vs. 9.1 ± 1.4 (P = 0.000), the mean forward flexion score was 4.3 ± 1.1 vs. 4.9 ± 0.2 (P = 0.000), the mean forward flexion strength was 4.0 ± 0.4 vs. 4.8 ± 0.4 (P = 0.000), the results were 16 excellent, 31 good and 2 bad. Forty-seven patients were satisfied with the operation. CONCLUSIONS: Arthroscopy is an effective method for the treatment of bursal-side partial-thickness rotator cuff tears. The key to the operation lies in bleeding control, proper acromioplasty and correct suturing method. This surgery has many advantages such as mini-invasion and rapid recovery.

Ghrelin attenuates infectious bursal disease virus-induced early inflammatory response and bursal injury in chicken.

Studies demonstrated that chicken ghrelin mRNA was expressed in immune organs of chicken. However, it was not known for its functions in chicken immune system. This study aimed to investigate the effects of ghrelin on infectious bursal disease virus (IBDV)-induced acute inflammatory and bursal injury. Chickens were divided into 4 groups. One group was used as control ("C"). The other three groups incubated with IBDV on the 19th d, of which 2 were injected intraperitoneally with 0.5 nmol ("LG") or 1.0 nmol ("HG") ghrelin/100g body weight from 18th to 22nd d, respectively, and one was injected intraperitoneally with PBS ("I"). Results showed that cytokines including interleukin (IL)-6, IL-1ß, and IL-8 mRNA expression in I group were upregulated significantly after chickens infected with IBDV from 1 d post-infection (dpi) to 3 dpi (P < 0.05). However, the expression level of IL-6, IL-1ß, and IL-8 mRNA in LG and HG groups was 7.3, ∼43.3% as much as that of the I group at 2 dpi and 3 dpi (P < 0.05). Moreover, ghrelin administration attenuated significantly the bursal injury from 1 dpi to 7 dpi and prevents the reduction of bird weight gain at 5 dpi and 7 dpi, which were induced by IBDV (P < 0.05). The results indicated that ghrelin could play an important role in the immune system of chicken.

MR imaging of the extensor mechanism.

Sports injuries of the knee involving the extensor mechanism are common. Specific conditions additionally affect the extensor mechanism in adolescents during growth and maturation, and in older patients as a result of degeneration. Prior to the advent of magnetic resonance (MR) imaging, the specific anatomical-pathological cause of anterior knee pain was often uncertain, with diagnosis limited to clinical examination and conventional radiographic assessment. MR imaging allows for the accurate and specific diagnosis of pathology of the extensor mechanism, impacting on decision making and clinical treatment of such conditions. In this article the anatomy, normal MR appearance, and common pathological conditions of the extensor mechanism of the knee are described.

Soft Tissue and Bony Injuries Attributed to the Practice of Yoga: A Biomechanical Analysis and Implications for Management.

OBJECTIVE: To analyze injuries that were directly associated with yoga practice and identify specific poses that should be avoided in patients with osteopenia or osteoporosis. PATIENTS AND METHODS: We retrospectively reviewed the medical records of patients with injuries that were primarily caused by yoga. Patients were seen from January 1, 2006, through December 31, 2018. Injuries were categorized into 3 groups: (1) soft tissue injury, (2) axial nonbony injury, and (3) bony injury. Patients underwent evaluation and were counseled to modify exercise activity. RESULTS: We identified 89 patients for inclusion in the study. Within the soft tissue group, 66 patients (74.2%) had mechanical myofascial pain due to overuse. Rotator cuff injury was seen in 6 (6.7%), and trochanteric bursopathy was observed in 1 (1.1%). In the axial group, exacerbation of pain in degenerative joint disease (46 patients [51.7%]) and facet arthropathy (n=34 [38.2%]) were observed. Radiculopathy was seen in 5 patients (5.6%). Within the bony injury category, kyphoscoliosis was seen on imaging in 15 patients (16.9%). Spondylolisthesis was present in 15 patients (16.9%). Anterior wedging was seen in 16 (18.0%), and compression fractures were present in 13 (14.6%). The poses that were most commonly identified as causing the injuries involved hyperflexion and hyperextension of the spine. We correlated the kinesiologic effect of such exercises on specific musculoskeletal structures. CONCLUSION: Yoga potentially has many benefits, but care must be taken when performing positions with extreme spinal flexion and extension. Patients with osteopenia or osteoporosis may have higher risk of compression fractures or deformities and would benefit from avoiding extreme spinal flexion. Physicians should consider this risk when discussing yoga as exercise.

Outcome of horses undergoing navicular bursotomy for the treatment of contaminated or septic navicular bursitis: 19 cases (2002-2016).

BACKGROUND: Contaminated or septic navicular bursitis has been reported to have a guarded prognosis after surgical treatment with navicular bursotomy only. In our experience, the use of navicular bursotomy for the treatment of this disease in combination with systemic and local delivery of antimicrobials can provide a good prognosis, even in horses with chronic disease. OBJECTIVE: To report the outcome of horses undergoing navicular bursotomy for the treatment of contaminated or septic navicular bursitis. STUDY DESIGN: Descriptive case series. METHODS: Navicular bursotomy was performed in combination with systemic and local antimicrobial therapies. Medical records (2002-2016) were reviewed. Follow-up information was obtained from owners or referring veterinarians. Horse outcome was divided into two groups. A successful outcome (Group 1) was assigned to horses that were able to return to the same level of use or performance as before contamination/infection. A satisfactory outcome (Group 2) was assigned to horses that survived but did not return to their previous function or level of performance. RESULTS: All horses survived to hospital discharge. Follow-up was obtained from 4 months to 12.75 years after surgery. Sixteen horses were able to return to their previous level of use (84.2%) and three horses were able to return to a lower level of performance or were pasture sound (15.8%). All 19 owners were satisfied with the outcome. MAIN LIMITATIONS: Small sample size and retrospective nature of the study. Follow-up was limited to telephone contact with owners and referring veterinarians, and there is potential for recall bias. CONCLUSIONS: Navicular bursotomy in combination with systemic and local antimicrobial therapies is an effective treatment for contaminated or septic navicular bursitis. The success rate in this population makes navicular bursotomy worthy of consideration in cases of contaminated or septic navicular bursitis, especially with chronicity and/or where equipment or expertise for bursoscopy is unavailable.

Massive prepatellar bursitis in cerebral palsy.

This case report describes a 36-year-old African American male with cerebral palsy and bilateral slowly enlarging knee masses. He has 90 degrees fixed flexion knee contractures bilaterally. Although he has poor communication skills, he does not have discomfort while ambulating. He has developed massive bilateral prepatellar bursitis from chronic and repetitive injury to the region bearing his body weight while ambulating. As the result of a protective response, the bursa provides a cushion for the underlying bone prominences of the tibial tubercle and patella. This compensatory mechanism has allowed the patient to have functional, painless household ambulation.

Massive prepatellar bursa.

An adult male with cerebral palsy was admitted to our institution with a massive prepatellar bursa. The condition resulted from the patient's use of crawling as a means of household ambulation. The bursa had become infected secondarily, prompting him to seek medical attention. The bursa was excised in its entirety, allowing for relief of his symptoms. The patient expired three years later from unrelated causes.

Inhomogeneous mechanical behavior of the human supraspinatus tendon under uniaxial loading.

Disorders of the rotator cuff, particularly tears of the rotator cuff tendons, cause significant shoulder disability. Among numerous factors thought to be responsible for the initiation and progression of supraspinatus tears are those related to the tendon's biomechanical properties. We hypothesized that in supraspinatus tendons subjected to tensile loading a strain gradient (difference) exists between the articular and bursal tendon surfaces, that regional strain differences exist on each of these two tendon surfaces, and that tendon surface strains vary with glenohumeral abduction. To test these hypotheses, the intrinsic inhomogeneous deformational characteristics of the articular and bursal surfaces of eight intact human cadaveric supraspinatus tendons were studied at three glenohumeral abduction angles using a novel multiple strain measuring system which simultaneously recorded surface marker displacements on two opposing soft tissue surfaces. Under applied tensile loads, the articular surface exhibited greater strain at 22 degrees (7.4+/-2.6% vs. 1.3+/-0.7%, p=0.0002) and 63 degrees (6.4+/-1.6% vs. 2.7+/-1.2%, p=0.0001) whereas the bursal surface exhibited greater strain at 90 degrees (7.6+/-2.8% vs. 4.9+/-0.4%, p=0.013). At all abduction angles, insertion strains were higher than those of the mid-tendon and tendon-muscle junction regions. The existence of inhomogeneous surface strains in the intact supraspinatus tendon demonstrates that intratendinous shear occurs within the tendon. The higher strain on the articular side of the tendon, especially at the insertion region, suggests a propensity for tears to initiate in the articular tendinous zone.

Matrix molecule mRNA levels in the bursa and rotator cuff of patients with full-thickness rotator cuff tears.

PURPOSE: The purpose of this study was to evaluate at the mRNA level a subset of extracellular matrix molecules relevant during healing and remodeling of rotator cuff tears. TYPE OF STUDY: Controlled laboratory study. METHODS: Bursal and rotator cuff tissue from the margin of the rotator cuff tear were harvested from 10 patients (mean age, 57.5 +/- 7.3 years) undergoing surgical repair of full-thickness rotator cuff tears. There were six male and four female patients with a mean duration of symptoms of 14.6 months (range, 2 to 60 months). The mean tear size was 4.4 cm. In addition, tissue was obtained from 6 cadaveric specimens with no gross evidence of rotator cuff tearing. Reverse transcription polymerase chain reaction (RT-PCR) was performed for type I, II, and III collagen, biglycan, decorin, and aggrecan, and normalized to the housekeeping gene GAPDH. RESULTS: RT-PCR showed that both the bursa and rotator cuff margin had increased mRNA levels for type I and type III collagen in patients with full-thickness rotator cuff tears when compared with normal cadaveric controls. In addition, there was a significant decrease in decorin mRNA levels and an increase in aggrecan mRNA levels in the rotator cuff margin of torn rotator cuff tendons when compared with normal cadaveric controls. CONCLUSIONS: These results suggest that both the bursa and rotator cuff margin of patients with rotator cuff tears are actively remodeling after injury and that both tissues may potentially contribute to the healing process following repair. CLINICAL RELEVANCE: These findings may help clinicians determine what aspects of the repair process can be manipulated to affect optimal ruptured tendon repair.