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1.
Sci Transl Med ; 16(744): eadd8273, 2024 Apr 24.
Artículo en Inglés | MEDLINE | ID: mdl-38657023

RESUMEN

Rotator cuff injuries result in more than 500,000 surgeries annually in the United States, many of which fail. These surgeries typically involve repair of the injured tendon and removal of the subacromial bursa, a synovial-like tissue that sits between the rotator cuff and the acromion. The subacromial bursa has been implicated in rotator cuff pathogenesis and healing. Using proteomic profiling of bursa samples from nine patients with rotator cuff injury, we show that the bursa responds to injury in the underlying tendon. In a rat model of supraspinatus tenotomy, we evaluated the bursa's effect on the injured supraspinatus tendon, the uninjured infraspinatus tendon, and the underlying humeral head. The bursa protected the intact infraspinatus tendon adjacent to the injured supraspinatus tendon by maintaining its mechanical properties and protected the underlying humeral head by maintaining bone morphometry. The bursa promoted an inflammatory response in injured rat tendon, initiating expression of genes associated with wound healing, including Cox2 and Il6. These results were confirmed in rat bursa organ cultures. To evaluate the potential of the bursa as a therapeutic target, polymer microspheres loaded with dexamethasone were delivered to the intact bursae of rats after tenotomy. Dexamethasone released from the bursa reduced Il1b expression in injured rat supraspinatus tendon, suggesting that the bursa could be used for drug delivery to reduce inflammation in the healing tendon. Our findings indicate that the subacromial bursa contributes to healing in underlying tissues of the shoulder joint, suggesting that its removal during rotator cuff surgery should be reconsidered.


Asunto(s)
Bolsa Sinovial , Ratas Sprague-Dawley , Lesiones del Manguito de los Rotadores , Manguito de los Rotadores , Tendones , Cicatrización de Heridas , Animales , Lesiones del Manguito de los Rotadores/patología , Lesiones del Manguito de los Rotadores/metabolismo , Lesiones del Manguito de los Rotadores/cirugía , Humanos , Bolsa Sinovial/patología , Bolsa Sinovial/metabolismo , Tendones/patología , Tendones/metabolismo , Masculino , Manguito de los Rotadores/patología , Ratas , Dexametasona/farmacología , Dexametasona/uso terapéutico , Femenino
2.
Tissue Cell ; 88: 102370, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38598871

RESUMEN

The subacromial bursa (SAB) plays an important role in the tendon healing process. Based on previous reports, co-culture of the rotator cuff (RC) and SAB have been shown to increase the tendon-related gene expressions, inflammatory cytokines, and tensile strength. However, the nature of the specific biochemical alterations during the inflammatory and repair phases of tendon healing with or without the SAB remain unknown. Using a full-thickness RC tear rat model, we determined how the presence or absence of the SAB alters the histological characteristics and gene expressions. After 3 and 6 weeks, tissues were collected for histological and real-time quantitative polymerase chain reaction (RT-qPCR) evaluations. Results showed greater cell density at 3 weeks, neovascularization and tendon thickening at 6 weeks with SAB preservation. Immunostaining revealed significant increases in type 3 collagen (COL3) expression at 6 weeks with SAB preservation. The RT-qPCR results showed that SAB preservation induced significant increases in the expression of scleraxis, matrix metalloproteinase-13 (MMP-13), interleukin-1ß (IL-1ß), and inducible nitric oxide synthase (iNOS) at 3 weeks and significant increases in COL3, IL-10, and arginase-1 (Arg-1) at 6 weeks. An RC tear undergoes more appropriate inflammatory and repair phases during the tendon healing process when the SAB is retained.


Asunto(s)
Bolsa Sinovial , Modelos Animales de Enfermedad , Ratas Sprague-Dawley , Lesiones del Manguito de los Rotadores , Manguito de los Rotadores , Animales , Lesiones del Manguito de los Rotadores/patología , Lesiones del Manguito de los Rotadores/metabolismo , Ratas , Manguito de los Rotadores/metabolismo , Manguito de los Rotadores/patología , Bolsa Sinovial/metabolismo , Bolsa Sinovial/patología , Masculino , Tendones/metabolismo , Tendones/patología , Cicatrización de Heridas , Regulación de la Expresión Génica
3.
J Am Vet Med Assoc ; 261(9): 1380-1387, 2023 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-37225156

RESUMEN

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.


Asunto(s)
Infecciones Bacterianas , Bursitis , Enfermedades de los Caballos , Sinovitis , Caballos , Animales , Bolsa Sinovial/lesiones , Bolsa Sinovial/patología , Bolsa Sinovial/cirugía , Bursitis/diagnóstico , Bursitis/veterinaria , Bursitis/cirugía , Inflamación/veterinaria , Sinovitis/diagnóstico por imagen , Sinovitis/veterinaria , Radiografía , Infecciones Bacterianas/veterinaria , Enfermedades de los Caballos/diagnóstico por imagen , Enfermedades de los Caballos/cirugía , Estudios Retrospectivos
4.
Skeletal Radiol ; 52(11): 2099-2106, 2023 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-36764945

RESUMEN

The cause of knee osteoarthritis (OA) and knee pain associated with OA is not well understood. Periarticular cystic lesions and bursae around the knee are among the most common morphologic features identified on MRI in the setting of OA. Despite widespread association of these lesions with knee OA and their inclusion in semiquantitative MRI scoring assessment systems for knee OA, the role that these lesions play in the development of knee pain and OA remains uncertain. In this discussion, we review the cystic lesions and bursae most commonly associated with OA of the knee, examine their relation and role in whole organ imaging assessments of OA, and present the literature investigating the associations of periarticular cysts and cyst-like lesions with knee pain and OA.


Asunto(s)
Osteoartritis de la Rodilla , Humanos , Osteoartritis de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/patología , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/patología , Rodilla/patología , Bolsa Sinovial/patología , Imagen por Resonancia Magnética/métodos , Dolor
5.
Skeletal Radiol ; 52(5): 967-978, 2023 May.
Artículo en Inglés | MEDLINE | ID: mdl-36008730

RESUMEN

The native bursa is a structure lined by synovium located adjacent to a joint which may serve to decrease friction between the tendons and overlying bone or skin. This extra-articular structure can become inflamed resulting in bursitis. Steroid injections have proven to be an effective method of treating bursal pathology in various anatomic locations. Performing these procedures requires a thorough understanding of relevant anatomy, proper technique, and expected outcomes. Ultrasound is a useful tool for pre procedure diagnostic evaluation and optimizing needle position during these procedures while avoiding adjacent structures. The purpose of this article is to review core principles of ultrasound-guided musculoskeletal procedures involving bursae throughout the upper and lower extremities.


Asunto(s)
Bolsa Sinovial , Bursitis , Humanos , Bolsa Sinovial/patología , Bursitis/terapia , Ultrasonografía/métodos , Inyecciones , Ultrasonografía Intervencional/métodos , Inyecciones Intraarticulares/métodos
6.
J Man Manip Ther ; 31(3): 206-213, 2023 06.
Artículo en Inglés | MEDLINE | ID: mdl-36309809

RESUMEN

INTRODUCTION: The subacromial/subdeltoid bursa can develop inflammation and effusion related to autoimmune, infectious, and musculoskeletal disorders. Rice bodies, or loose bodies within bursa, have been described as an uncommon complication of bursitis and have been the subject of case studies over a number of years. However, they have not been described in anatomical or physical therapy-related literature. METHODS: A donor body dissected for a physical therapy anatomy course was found to have an enlarged subacromial/subdeltoid bursa. This bursa, along with the biceps brachii tendon sheath, and the subscapularis muscle bursa, were filled with numerous rice-like bodies. The bursal wall was well developed and thickened. Tissue specimens were obtained of the suspected rice bodies, the subacromial/subdeltoid bursal wall, and the biceps brachii tendon sheath. The tissue was embedded, sectioned, and processed with hematoxylin and eosin or Masson's Trichrome staining for blinded histologic assessment. RESULTS: The tissue samples from within the bursa were identified as tissue similar to that in prior descriptions of rice bodies. Tissue samples from the bursal wall and tendon sheath were identified as similar to synovial membranes. CONCLUSIONS: Rice bodies found within the cadaveric body were similar histologically to those described in rheumatology, radiology, and orthopedic literature. Anatomists teaching future health-care providers and practicing physical therapists should be familiar with rice bodies as a potential finding in cadavers, and patients.


Asunto(s)
Bursitis , Cuerpos Libres Articulares , Articulación del Hombro , Humanos , Hombro/patología , Bolsa Sinovial/patología , Bursitis/terapia , Articulación del Hombro/patología , Cuerpos Libres Articulares/complicaciones , Cuerpos Libres Articulares/patología , Cadáver
7.
Dis Markers ; 2022: 9660067, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36016850

RESUMEN

Objective: To explore the application value of musculoskeletal ultrasound in the diagnosis and conservative treatment of knee osteoarthritis. Methods: Patients with knee osteoarthritis who were treated in our hospital from January 1, 2020 to August 31, 2021 were selected as the research subjects. The subjects underwent musculoskeletal ultrasonography to record the thickness of the lateral femoral malleolus cartilage, the thickness of the medial femoral malleolus cartilage, the depth of the suprapatellar bursa effusion, and the thickness of the suprapatellar bursa synovium. All patients in the study group received acupuncture treatment after musculoskeletal ultrasonography, and musculoskeletal ultrasonography was performed again after 2 weeks of treatment. The differences in musculoskeletal ultrasound-related parameters were compared between the two groups. Results: The thickness of the lateral femoral malleolus cartilage and medial femoral malleolus cartilage in the study group was significantly smaller than those in the control group. The depth of the effusion in the suprapatellar bursa and the thickness of the synovial membrane in the suprapatellar bursa were significantly greater than those in the control group. Ultrasonography showed no significant difference in abnormal status compared with arthroscopy, and musculoskeletal ultrasonography revealed knee osteoarthritis, such as cruciate ligament injury, joint effusion, synovial hyperplasia, meniscus injury, and patellar ligament injury. The cartilage thickness of the lateral femoral malleolus and medial malleolus of femur after treatment were significantly greater than those before treatment. The depth of the deep suprapatellar bursa effusion and the thickness of the suprapatellar bursa synovium were significantly smaller than those before treatment. Conclusion: Musculoskeletal ultrasound has high diagnostic value in knee osteoarthritis. It can detect the lesion as soon as possible and can be used to evaluate the effect of conservative treatment, so as to provide reference basis for clinical formulation or adjustment of further intervention plan.


Asunto(s)
Osteoartritis de la Rodilla , Bolsa Sinovial/diagnóstico por imagen , Bolsa Sinovial/patología , Tratamiento Conservador , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/patología , Osteoartritis de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/terapia , Ultrasonografía
8.
Magn Reson Imaging Clin N Am ; 30(2): 241-260, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-35512888

RESUMEN

The main function of the knee bursae is to provide cushioning for the many periarticular ligaments, tendons, and osseous structures. Bursae can only be visualized when distended by fluid, therefore bursal anatomy is best evaluated by MR imaging using fluid-sensitive sequences. Knowledge of the normal bursal distribution is important to avoid incorrectly interpreting a distended bursa as a periarticular fluid collection or cyst. Bursal pathology usually results from trauma, chronic overuse, or inflammation, and may be associated with an underlying intra-articular process, given the presence of synovial lining and different degrees of communication with the joint.


Asunto(s)
Bursitis , Bolsa Sinovial/anatomía & histología , Bolsa Sinovial/patología , Bursitis/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética/métodos
9.
Connect Tissue Res ; 63(3): 287-297, 2022 05.
Artículo en Inglés | MEDLINE | ID: mdl-34042553

RESUMEN

PURPOSE/AIM: The purpose of this study is to identify a cell population within the murine subcromial bursal-derived cells with characteristics compatible to an accepted mesenchymal stem cell description given by the International Society for Cellular Therapy (ISCT). MATERIALS AND METHODS: Murine subacromial bursa was harvested using microsurgical technique. Subacromial bursal-derived cells were classified through colony-forming units, microscopic morphology, fluorescent-activated cell sorting, and differentiation into chondrogenic, adipogenic, and osteogenic lineages. RESULTS: Subacromial bursal samples exhibited cell growth out of the tissue for an average of 115 ± 29 colony-forming units per 1 mL of complete media. Subacromial bursal-derived cells exhibited a long, spindle-shaped, fibroblast-like morphology. Subacromial bursal-derived cells positively expressed mesenchymal stem cell markers CD73, CD90, and CD105, and negatively expressed mesenchymal stem cell markers CD31 and CD45. Subacromial bursal-derived cells, examined by Image J analysis and quantitative gene expression, were found to differentiate into chondrogenic, adipogenic, and osteogenic lineages. CONCLUSIONS: This study demonstrated the feasibility of harvesting murine subacromial bursal tissue and identified a cell population within the subacromial bursa with characteristics compatible to an accepted mesenchymal stem cell description. The results of this study suggest that the mouse subacromial bursal-derived cell population harbors mesenchymal stem cells. Murine subacromial bursal tissue is a potential source for obtaining cells with mesenchymal stem cell characteristics for future utilization in orthopedic research to look into treatment of rotator cuff pathology.


Asunto(s)
Células Madre Mesenquimatosas , Lesiones del Manguito de los Rotadores , Articulación del Hombro , Animales , Bolsa Sinovial/patología , Diferenciación Celular , Ratones , Manguito de los Rotadores/patología , Lesiones del Manguito de los Rotadores/patología
10.
Acta Radiol ; 63(8): 1043-1050, 2022 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34171969

RESUMEN

BACKGROUND: Lipoma arborescens is characterized by the villous proliferation of the synovium and diffuse hyperplasia of fatty tissue in the subsynovial layer, almost always with a periarticular lesion. According to past articles, fewer cases have depicted the imaging features of lipoma arborescens. PURPOSE: To evaluate the computed tomography (CT) and magnetic resonance imaging (MRI) features of lipoma arborescens. MATERIAL AND METHODS: The imaging features of 15 patients with pathologically proven lipoma arborescens were retrospectively analyzed including lesion number, shape, location, size, margins, attenuation on CT, and signal intensity and enhancement patterns on MR images. RESULTS: All cases (n=15) showed joint or bursa effusion. The primary lesion attached to the bursa wall adjacent to the bone in 13 cases and to the lateral wall in two cases. CT shows a mass with fatty tissue attenuation values in the suprapatellar pouch (n=3) or subdeltoid bursa with an erosion of the humeral head (n=2), among them two cases showed branched slightly high density in the center of the fat density tissue. Fifteen cases on routine MRI display mass-like subsynovial mass with fatty tissue signal on all of the sequences and suppression of the signal on fat-suppression sequences. Among them, five lesions showed branched slightly low T1-weighted imaging, high proton density-weighted imaging, and T2-weighted imaging signals in the center. It showed the enhancement of the linear surface and the bursa wall in contrast-enhanced MRI (n=3). CONCLUSION: Lipoma arborescens have specific CT and MRI features that enable them to make a conclusive diagnosis of this rare condition, which helps the diagnosis before treatment.


Asunto(s)
Lipoma , Bolsa Sinovial/patología , Humanos , Hiperplasia/patología , Lipoma/diagnóstico por imagen , Lipoma/patología , Imagen por Resonancia Magnética , Estudios Retrospectivos , Membrana Sinovial/patología
11.
Chem Biol Interact ; 351: 109720, 2022 Jan 05.
Artículo en Inglés | MEDLINE | ID: mdl-34717913

RESUMEN

Ochratoxin A (OTA) is a fungal secondary metabolite produced by certain species of Aspergillus and Penicillium, and exerts immunosuppressive effect on humans and animals. Quercetin (QUE) is one of the flavonoids produced as a plant-secondary metabolite. The present study was designed to evaluate the efficacy of QUE against the immunotoxic hazard of OTA in broiler chickens. Forty one-day-old broiler chicks were randomly and equally allocated into four groups; control, OTA (0.5 mg/kg feed), QUE (0.5 g/kg feed) and OTA + QUE (0.5 mg/kg OTA + 0.5 g/kg QUE). The results revealed that dietary OTA induced a significant decrease in the antibody response to Newcastle Disease (ND), Infectious Bronchitis (IB) and Avian Influenza (AI) vaccination and in the lymphoproliferative response to Phytohemagglutinin-P (PHA-P). Ochratoxin A also induced oxidative stress and lipid peroxidation in the bursa of Fabricius, spleen and thymus tissues of chickens as demonstrated by decreased CAT and GSH levels and increased TBARS content. In addition, administration of OTA resulted in apoptosis, which was evident by the increased expression level of PTEN, Bax and Caspase-3 genes and decreased expression level of PI3K, AKT and Bcl-2 genes. Furthermore, exposure to OTA resulted in various pathological lesions in the bursa of Fabricius, spleen and thymus of chickens. On the other hand, administration of QUE ameliorated most of the immunotoxic effects of OTAby its immunomodulatory, antioxidant and anti-apoptotic activities. Taken together, the results suggested that QUE potentially alleviated the OTA-induced immunotoxicity in broiler chickens, probably through amelioration of oxidative stress and activation of the PI3K/AKT signaling pathway.


Asunto(s)
Antioxidantes/uso terapéutico , Factores Inmunológicos/uso terapéutico , Ocratoxinas/toxicidad , Quercetina/uso terapéutico , Transducción de Señal/efectos de los fármacos , Animales , Formación de Anticuerpos/efectos de los fármacos , Proteínas Aviares/metabolismo , Bolsa Sinovial/efectos de los fármacos , Bolsa Sinovial/patología , Pollos , Expresión Génica/efectos de los fármacos , Estrés Oxidativo/efectos de los fármacos , Fosfatidilinositol 3-Quinasas/metabolismo , Proteínas Proto-Oncogénicas c-akt/metabolismo , Bazo/efectos de los fármacos , Bazo/patología , Timo/efectos de los fármacos , Timo/patología
12.
Arthroscopy ; 38(4): 1115-1123, 2022 04.
Artículo en Inglés | MEDLINE | ID: mdl-34767955

RESUMEN

PURPOSE: To build upon previous literature to identify a complete analysis of cellular contents of subacromial bursal tissue as well as the matrix surrounding the rotator cuff. METHODS: Samples of subacromial bursal tissue and surrounding matrix milieu from above the rotator cuff tendon and above the rotator cuff muscle bellies were obtained from 10 patients undergoing arthroscopic rotator cuff repair. Samples were analyzed using fluorescent-activated cell sorting and histologic analysis with staining protocols (Oil Red O, Alcian Blue, and Picro-Sirius Red), for identification of matrix components, including fat, proteoglycans, and collagen. RESULTS: Progenitor cells and fibroblast-type cells were present in significant amounts in subacromial bursal tissue in both tissues obtained from over the tendinous and muscle belly portions. Markers for neural tissue, myeloid cells, and megakaryocytes also were present to a lesser extent. There were prominent amounts of fat and proteoglycans present in the matrix, based on ImageJ analysis of stained histologic slides. CONCLUSIONS: The subacromial bursal tissue and surrounding matrix of patients undergoing rotator cuff repair contains progenitor cells in significant concentrations both over the tendon and muscle belly of the rotator cuff. CLINICAL RELEVANCE: This presence of progenitor cells, in particular, in the subacromial bursal tissue provides a potential basis for future applications of augmentation purposes in rotator cuff healing, and calls into question the practice of routine bursectomy. As the potential role of bursal tissue contents in growth and regeneration in the setting of rotator cuff healing is more well understood, maintaining this tissue may become more relevant. Concentration of these cellular components for use in autologous re-implantation is also an avenue of interest.


Asunto(s)
Lesiones del Manguito de los Rotadores , Manguito de los Rotadores , Bolsa Sinovial/patología , Bolsa Sinovial/cirugía , Humanos , Manguito de los Rotadores/cirugía , Lesiones del Manguito de los Rotadores/patología , Lesiones del Manguito de los Rotadores/cirugía , Células Madre , Tendones/cirugía
13.
JBJS Rev ; 9(11)2021 11 10.
Artículo en Inglés | MEDLINE | ID: mdl-34757977

RESUMEN

¼: The subacromial bursa is a distinct anatomic structure with distinct histologic features; it plays a critical role in the symptoms of the painful shoulder and in the local healing capacity of the rotator cuff tendon. ¼: Treatment of pain from bursitis of the subacromial bursa largely involves nonoperative interventions; however, operative treatment may be considered in certain instances. ¼: Preservation of the subacromial bursa should occur whenever possible given its intrinsic trophic and pluripotent factors, which have been shown to play important roles in rotator cuff tendon pathology.


Asunto(s)
Lesiones del Manguito de los Rotadores , Bolsa Sinovial/patología , Bolsa Sinovial/cirugía , Humanos , Manguito de los Rotadores/patología , Manguito de los Rotadores/cirugía , Lesiones del Manguito de los Rotadores/patología , Lesiones del Manguito de los Rotadores/cirugía , Hombro/patología , Tendones
14.
JBJS Case Connect ; 11(2)2021 04 14.
Artículo en Inglés | MEDLINE | ID: mdl-33979812

RESUMEN

CASE: A 71-year-old man presented with extreme anterior knee pain. His history, physical examination, and imaging were consistent with prepatellar bursitis, but his pain seemed out of proportion for these findings. The patient eventually underwent marginal excision of the inflamed prepatellar bursa which histopathology identified as a glomangioma. Postoperatively, he has complete resolution of his pain and has returned to his daily activities. CONCLUSION: Glomus tumors are a rare cause of severe knee pain that completely resolves after excision. In the patient with extreme, localized knee sensitivity, it is important to consider this pathology even if no mass is identified on imaging.


Asunto(s)
Tumor Glómico , Anciano , Bolsa Sinovial/patología , Bolsa Sinovial/cirugía , Tumor Glómico/diagnóstico por imagen , Tumor Glómico/cirugía , Humanos , Rodilla/patología , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/patología , Articulación de la Rodilla/cirugía , Imagen por Resonancia Magnética , Masculino
15.
Scand J Med Sci Sports ; 31(2): 480-488, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32965721

RESUMEN

Shoulder problems are common in volleyball and greatly impede both training and player performance. Subacromial bursa (SAB) thickening and tendon neovascularity have shown relevance in other populations, but their relationship with the development of shoulder complaints has not been investigated in volleyball players or overhead-throwing athletes. The study aim was to examine the role of SAB thickness, neovascularization of the supraspinatus tendon, shoulder strength, range of motion (ROM), player position, and age in the development of shoulder complaints in professional volleyball players. Players underwent preseason baseline testing (n = 86) and reported shoulder complaints during the subsequent 12-week period. Generalized estimating equations were used to model for probabilities of complaints after adjusting for player position, SAB side-to-side difference, neovessel presence, shoulder external rotation (ER) ROM, and age. Outside hitters and opposites were 12.2-fold more likely to develop complaints, and greater shoulder ER ROM increased risk by 8% for each additional degree. A side-to-side difference in SAB thickness ≥0.3 mm in the dominant compared with the non-dominant arm was associated with a 10.2-fold increased risk. Those with neovessels were 6.5 times more likely to develop complaints. Players without neovessels and with normal SAB thickness were very unlikely to develop complaints. This stark contrast to players with neovessels or increased SAB thickness, where nearly half of the players developed complaints, is of interest. Players with current complaints at baseline presented with greater IR:ER strength ratios; however, neither strength nor IR ROM at baseline was associated with an increased risk of developing complaints.


Asunto(s)
Bolsa Sinovial/patología , Artropatías/etiología , Neovascularización Patológica/complicaciones , Rango del Movimiento Articular , Manguito de los Rotadores/irrigación sanguínea , Voleibol/lesiones , Adulto , Factores de Edad , Fenómenos Biomecánicos/fisiología , Lateralidad Funcional , Humanos , Artropatías/diagnóstico por imagen , Masculino , Fuerza Muscular , Probabilidad , Estudios Prospectivos , Adulto Joven
16.
Knee Surg Sports Traumatol Arthrosc ; 29(7): 2228-2236, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32356046

RESUMEN

PURPOSE: To analyze biopsy samples from the subscapularis tendon and from the joint capsule from male patients with subacromial impingement syndrome and compare them with samples from male patients with post-traumatic recurrent shoulder instability, to detect increased inflammatory activity that might be present inside the humeroscapular joint. METHODS: Twenty male patients scheduled for surgery for either subacromial decompression or Bankart reconstruction were included. Four biopsies from each patient were obtained during surgery from the capsule and the subscapularis tendon. Each specimen was analyzed for TNF-α, IL-6, CD-3 and CD-72. Multiplex fluorescence immunohistochemistry was performed on histological samples from the capsule and tendon to demonstrate the level of inflammatory markers. Fluorescence microscope images were acquired using an automated scanning system. On each slide, the number of pixels was registered and used in the analyses. RESULTS: The subacromial impingement syndrome group comprised eight patients, median age 53 (45-74) years, while the instability group 12, median age 27 (22-48) years (p < 0.00001). The amount of IL-6 and TNF-α was significantly higher in the subscapularis tendon of the patients with subacromial impingement syndrome compared with instability patients (p = 0.0015 and p = 0.0008 respectively). In the capsular samples, significantly higher amount of TNF-α and CD-72 was found in patients with subacromial impingement syndrome compared with instability patients (p < 0.0001 for both). On the other hand, the amount of CD-3 was significantly higher in the instability group (p = 0.0013). CONCLUSIONS: This study provides evidence that an extended inflammatory process is present, not only in the subacromial bursa but also in the glenohumeral joint in patients with subacromial impingement syndrome. LEVEL OF EVIDENCE: Level III. CLINICAL RELEVANCE: To develop a treatment targeted towards intra-articular inflammatory cytokines appears appealing.


Asunto(s)
Citocinas/análisis , Cápsula Articular/patología , Manguito de los Rotadores/patología , Síndrome de Abducción Dolorosa del Hombro/patología , Tendones/patología , Anciano , Biomarcadores/análisis , Biopsia/métodos , Bolsa Sinovial/patología , Descompresión Quirúrgica/métodos , Humanos , Inflamación/metabolismo , Interleucina-6/análisis , Cápsula Articular/cirugía , Inestabilidad de la Articulación/sangre , Inestabilidad de la Articulación/cirugía , Masculino , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Manguito de los Rotadores/cirugía , Hombro/cirugía , Síndrome de Abducción Dolorosa del Hombro/cirugía , Articulación del Hombro/cirugía , Tendones/cirugía , Factor de Necrosis Tumoral alfa/análisis
18.
Medicine (Baltimore) ; 99(34): e21759, 2020 Aug 21.
Artículo en Inglés | MEDLINE | ID: mdl-32846802

RESUMEN

RATIONALE: Subacromial-subdeltoid (SASD) bursitis is characterized by bursal distension caused by fluid collection, commonly resulting from rotator cuff tears. Aspiration of the bursal fluid associated with rotator cuff tears tends to be overlooked. The effects of combined bursal aspiration and corticosteroid injection on full-thickness tears of the rotator cuff with SASD bursitis have not been previously reported. PATIENT CONCERNS: We report the cases of 3 patients with shoulder pain caused by rotator cuff tears with marked amounts of fluid in the SASD bursa. The patients experienced intractable pain despite previous conservative management, including corticosteroid injection. DIAGNOSES: Physical examination and imaging studies revealed rotator cuff tears with remarkable quantities of fluid in the SASD bursa. INTERVENTIONS AND OUTCOMES: The patients underwent ultrasound (US)-guided aspiration of the bursal fluid and intra-articular corticosteroid injection, following which, all patients experienced reduced shoulder pain for several months. LESSONS: Combined aspiration of fluid in the SASD bursa and intra-articular corticosteroid injection in the rotator cuff tear is recommended, especially in cases with untreated shoulder pain unresponsive to previous conservative management.


Asunto(s)
Corticoesteroides/uso terapéutico , Artrocentesis/métodos , Lesiones del Manguito de los Rotadores/terapia , Anciano , Bolsa Sinovial/patología , Humanos , Inyecciones Intraarticulares , Masculino , Lesiones del Manguito de los Rotadores/patología , Ultrasonografía , Ultrasonografía Intervencional
19.
Arthroscopy ; 36(8): 2057-2068, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32305423

RESUMEN

PURPOSE: To classify subacromial bursal tissue using intraoperative and in vitro characteristics from specimens harvested during arthroscopic shoulder surgery. METHODS: Subacromial bursa was harvested over the rotator cuff from 48 patients (57 ± 10 years) undergoing arthroscopic shoulder surgery. Specimens were characterized intraoperatively by location (over rotator cuff tendon or muscle), tissue quality (percent of either fatty or fibrous infiltration), and vascularity before complete debridement. Nucleated cell counts were determined after 3 weeks incubation and histological sections were reviewed for degree of fatty infiltration and vascularity. Mesenchymal stem cell surface markers were counted via flow cytometry (n = 3) and cellular migration was observed using a fluoroscopic assay (n = 3). RESULTS: Intraoperatively, muscle bursa was found most often to have >50% fatty infiltration (n = 39), whereas tendon bursa showed majority fibrous tissue (n = 32). Cellular proliferation did not significantly differ according to intraoperative tissue quality. Intraoperative vascularity was associated with greater proliferation for highly vascular samples (P = 0.023). Tendon bursa demonstrated significantly greater proliferation potential than muscle bursa (P = 0.00015). Histologic assessment of fatty infiltration was moderately correlated with gross tissue fattiness (ρ = -0.626, P = 7.14 × 10-11). Flow cytometry showed that 90% to 100% of bursal cells were positive for MSC surface markers. Peak cellular migration rates occurred between 18 and 30 hours' incubation. CONCLUSIONS: Intraoperative and in vitro subacromial bursa characteristics were not found to reliably correlate with the degree of cellular proliferation. However, the anatomic location of subacromial bursa was consistently predictive of increased proliferation potential. Bursa-derived nucleated cells were confirmed to include mesenchymal stem cells with migratory potential. CLINICAL RELEVANCE: The anatomic distinction between muscle and tendon bursa provides a simple classification for predicting cellular activity.


Asunto(s)
Bolsa Sinovial/patología , Artropatías/patología , Artropatías/cirugía , Articulación del Hombro/patología , Articulación del Hombro/cirugía , Adulto , Anciano , Artroscopía , Biopsia , Bolsa Sinovial/cirugía , Proliferación Celular , Femenino , Humanos , Masculino , Células Madre Mesenquimatosas/patología , Persona de Mediana Edad , Músculo Esquelético/patología , Hombro/patología , Hombro/cirugía , Tendones/patología
20.
Libyan J Med ; 15(1): 1753943, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32281500

RESUMEN

Knee Osteoarthritis is a considerable public health concern, both in terms of life quality and treatment financial impacts. To investigate this disease, animal models are deemed a promising alternative. In fact, although a perfect model is generally farfetched, the creation of models that simulate human disease as accurately as possible remains an important research stake. This study aims to highlight the usefulness of the model induced by injected Mono-Iodo-Acetate and to standardize it for the rabbit species. Osteoarthritis was induced by an infra-patellar injection of 0.2 ml of an MIA solution in the left knee of 24 female New Zealand rabbits. The right knee served as a control by receiving an injection of physiological serum. The rabbits were divided into 4 groups of 6 individuals each according to the dose of MIA received per knee. All rabbits were euthanized 30 days after the injection. After sacrifice, the knees were carefully dissected and macroscopic and microscopic scores of cartilage, meniscal and synovial lesions were attributed to each group. Our study followed the laboratory animal care and management guideline published in 2017 by the Canadian Council of Animal Care. The control knees of all rabbits showed no macroscopic or microscopic lesions. The macroscopic lesions: osteophytes, meniscal lesions, fibrillation and erosion of the cartilage and microscopic lesions: disorganization of the chondrocytes, decrease in proteoglycans and synovial inflammation clinically diagnosed in human pathology were all detected and were similarly reproducible among the knees of the same group. Through this work, we highlighted the merits of the arthritis model induced by MIA, namely its simulation of several aspects of human pathology. Further advantages are low cost, speed, reproducibility. This model notably avoids delicate and risky surgical operations.


Asunto(s)
Inhibidores Enzimáticos/administración & dosificación , Ácido Yodoacético/administración & dosificación , Osteoartritis de la Rodilla/inducido químicamente , Animales , Bolsa Sinovial/patología , Bolsa Sinovial/ultraestructura , Canadá/epidemiología , Cartílago/patología , Cartílago/ultraestructura , Condrocitos/patología , Modelos Animales de Enfermedad , Inhibidores Enzimáticos/efectos adversos , Femenino , Humanos , Inyecciones/métodos , Ácido Yodoacético/efectos adversos , Menisco/patología , Menisco/ultraestructura , Osteoartritis de la Rodilla/patología , Osteoartritis de la Rodilla/veterinaria , Proteoglicanos/metabolismo , Conejos , Reproducibilidad de los Resultados
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