Shoulder pain and intra-articular interleukin-8 levels in patients with rotator cuff tears.

AIM: Rotator cuff disease (RCD) is one of the most common disorders in the shoulder joint and causes joint pain and functional disability. In this study, we investigated the associations among cytokine levels and clinical symptoms in patients with RCD. METHOD: Joint fluid specimens of the shoulder joint were obtained from 38 patients with RCD before arthroscopic surgery. The levels of inflammatory cytokines, including interleukin (IL)-1ß, IL-6 and IL-8, were evaluated using enzyme-linked immunosorbent assay kits, and the associations between these cytokine levels and the clinical symptoms were determined. A multiple linear regression analysis was performed to identify the parameters accounting for the visual analogue scale (VAS) score at rest. RESULTS: IL-8 level was correlated with IL-6 (r = 0.434, P = 0.006) and IL-1ß (r = 0.575, P < 0.001) levels. The cuff tear size was inversely correlated with the VAS score at rest. A multiple stepwise linear regression analysis revealed that the VAS score at rest could be explained by the VAS score at night, the VAS score during movement and the intra-articular IL-8 level (adjusted R² = 0.544, P < 0.001). The intra-articular IL-8 level is associated with resting pain in rotator cuff tear patients. CONCLUSION: These results suggest that an increased concentration of IL-8 is associated with resting pain in rotator cuff tear patients.

[Effects of acupuncture treatment on natural killer cell activity, pulse rate, and pain reduction for older adults: an uncontrolled, observational study].

OBJECTIVE: The aim of this study was to examine the changes in natural killer (NK) cell activity, pulse rate, and pain intensity among older adults before and after acupuncture treatment. METHODS: Fifty-six individuals (16 males and 40 females), age 60 to 82 years (mean age 72.4 ± 5.0), who were experiencing pain in the shoulder, low back, or knee, participated in the study. NK cell activity, leukocyte differentiation (granulocytes and lymphocytes), pulse rate, and blood pressure values obtained. Pain intensity was used to analyze NK cell activity, leukocytes (granulocyte counts and granulocyte-to-lymphocyte ratio), and the VAS score in accordance with the location of pain complaints before and after acupuncture treatment. RESULTS: NK cell activity decreased after acupuncture treatment for pain in the shoulder-pain and knee-pain groups. Further, the lymphocyte and granulocyte counts increased after acupuncture treatment for the shoulder-pain group. Pulse rate decreased for the shoulder-pain, low-back-pain, and knee-pain groups after acupuncture treatment. The VAS score decreased after acupuncture treatment for the shoulder-pain, low-back-pain, and knee-pain groups. CONCLUSION: This study showed that in older adults, acupuncture treatment decreases pulse rate, relieves pain in the shoulder, low back, and knee, and reduces NK-cell activity.

Increased interleukin 1ß levels in the subacromial fluid in diabetic patients with rotator cuff lesions compared with nondiabetic patients.

BACKGROUND: Diabetic patients have a high prevalence of shoulder pain and stiffness. Interleukin (IL) 1ß was reportedly correlated with shoulder stiffness and decreased shoulder function. We retrospectively compared the expression of IL-1ß in the subacromial synovial fluid between diabetic and nondiabetic patients with rotator cuff tearing. MATERIALS AND METHODS: We enrolled 68 patients with rotator cuff tearing (23 diabetic patients and 45 nondiabetic patients). The preoperative sum of range-of-motion deficit (SROMD), Constant score, and visual analog scale (VAS) score were obtained. Intraoperatively, subacromial synovial fluid was collected for the IL-1ß level measurement. Comparisons of IL-1ß levels, Constant scores, SROMD, and VAS scores between diabetic and nondiabetic patients were analyzed with the Mann-Whitney U test. RESULT: Diabetic patients with rotator cuff tearing had significantly increased subacromial IL-1ß levels (P = .048), SROMD (P < .001) and VAS scores (P = .022) and lower Constant scores (P < .001) than nondiabetic patients. The IL-1ß levels in the subacromial fluid were significantly correlated with the Constant score (r = -0.477, P < .001), VAS score (r = 0.698, P < .001), and SROMD (r = 0.293, P = .015) in all patients. CONCLUSION: The elevated IL-1ß levels in the subacromial fluid of patients with diabetes may explain the likelihood of pain and shoulder stiffness developing in these patients. We suggest more aggressive treatment for rotator cuff lesions in diabetic patients.

[Analgesic and anti-inflammatory effects of balance acupuncture on experimental scapulohumeral periarthritis in rabbits].

OBJECTIVE: To investigate therapeutic effects of balance acupuncture on scapulohumeral periarthritis (SP)and the mechanisms. METHODS: Thirty male New Zealand rabbits were randomly divided into a blank group (group B), a model group (group M) and a balance acupuncture group (group BA) with 10 rabbits in each group. SP model was established by using persistent mechanical strain and ice compress. Balance acupuncture at "Jiantong" point was applied in the animals in group BA, but not in the rabbits of the other two groups. Joint movement and pathological changes in tissues around the affected shoulder joint were observed, and interleukin-1beta (IL-1beta), 5-hydroxytryptamine (5-HT) in plasma and the affected surrounding tissues, and DNA contents in tendon of supraspinatus muscle were measured. RESULTS: The content of plasma 5-HT in group BA [(18.16 +/- 4.44) ng/mL] was significantly lower than that in group M [(23.28 +/- 5.89) ng/mL] (P < 0.05), but without obvious difference in IL-1beta content between the two groups (P > 0.05). Compared with group M, the contents of IL-1beta, 5-HT in affected surrounding tissues, and DNA expression in tendon of supraspinatus muscle were significantly lowered to va rious extent in group BA (P < 0.01, P < 0.05). CONCLUSION: Balance acupuncture can effectively improve local and systemic pathological situation induced by SP by way of reducing pain-producing factors, inflammatory factors and DNA expression to alleviate local organization and adhesions in rabbits with experimental SP.

Assessment of shoulder involvement and disability in patients with ankylosing spondylitis.

The purpose of the study was to evaluate the parameters which have an important role in shoulder involvement and disability in ankylosing spondylitis (AS). Ninety patients with AS were divided into two groups according to the presence of shoulder involvement. Bath AS metrology index (BASMI), ankylosing spondylitis quality of life (ASQoL) and shoulder pain and disability index (SPADI) were used. Ranges of movements of limited shoulders were measured. Mean disease duration, age, BASMI, and ASQoL were higher and hip involvement was more frequent in the shoulder-involved group. Disease duration was found to be the most significant factor in shoulder involvement. A significant relationship was found between all SPADI scores and ASQoL. The SPADI disability score was affected by flexion limitation. Patients with hip involvement and longer disease duration should be evaluated for shoulder involvement. Flexion limitation of shoulder affected shoulder disability and shoulder disability impaired quality of life.

Endocrine and immunologic parameters indicative of 6-month prognosis after the onset of low back pain or neck/shoulder pain.

STUDY DESIGN: Prospective study. OBJECTIVES: To evaluate the prognosis of spine disease by investigating biologic parameters reflecting different physiologic or psychophysiological systems in men and women with acute onset of low back or neck/shoulder complaints. SUMMARY OF BACKGROUND DATA: Psychosocial factors may be of importance to the etiology and prognosis of musculoskeletal disorders. The possible mechanisms, however, remain unclear. Stress-induced long-lasting energy mobilization resulting in inhibited anabolism has been discussed. Using a theoretical framework within stress physiology, such psychophysiological processes were recorded by measures of substances representing the anabolic, catabolic, immunologic, and opioid systems. METHODS: The study comprised 67 working men and women 21 to 59 years of age seeking care by any caregiver for acute low back and/or neck/shoulder pain. Blood samples were taken and analyzed for 3 methyl 5hydroxy phenylethylene glycol (MHPG, reflecting sympathoadrenomedullary activity), DHEA-s (anabolism), immunoglobulin E, interleukin 6 (immune activity), and beta-endorphin (pain regulation). The participants were followed up for 6 months after the blood samples had been drawn. RESULTS: In women, low MHPG, low DHEA-s, and low beta-endorphin predicted persistent disability due to low back complaints. Few significant findings were made for self-reported pain, for neck/shoulder complaints, and for men. CONCLUSION: Disturbances of the regulation of certain biologic parameters might be indicators of a prolonged course of low back disease in women. Prospective studies are necessary to enable causal conclusions.