Evaluation of Autologous Platelet Rich Plasma Injection in the Treatment of Rotator Cuff Tendinopathy

Background: Rotator cuff tendinopathy (RCT) is a significantsource of disability and loss of work. As commonly usedsubacromial corticosteroid injection for treatment of chronicrotator cuff tendinopathy has adverse effects especially inelderly people, new treatment options such as Platelet-RichPlasma (PRP) can be considered for managing of thispathology. The aim of the present study was conducted toevaluate the effectiveness of autologous platelet rich plasmainjection in the treatment of rotator cuff tendinopathy.Materials and Methods: The present study was conductedamong adults of age 30-70 years over the period of 1 year fromFeb 2018 to Jan 2019. The primary outcome measure for allparticipants was a score on a 0–10 visual analog scale (VAS)assessing current resting pain at baseline and at 8, 12, and 52weeks. Demographics and information about duration of RCTpain and prior therapies for RCT were collected. Eachparticipant underwent a single injection of PRP. In-personassessment occurred at 2, 8, and 12 weeks and by phone at52 weeks. Statistical analysis was done using SPSS 21software. P values less than .05 were considered statisticallysignificant for main and interaction effects.Results: In the present study total sample size was 46 inwhich 32 were males and 14 were females. VAS score wasevaluated for the treatment of Rotator cuff Tendinopathy atbaseline, 8 week, 12 week, 52 weeks after the injection ofautologous platelet rich plasma. The result shows that VASscore was less after 8 weeks and after 12 weeks and 52 weeksit was almost same.Conclusion: Our study concluded that pain was less in thepatients of Rotator cuff Tendinopathy after the injection ofautologous platelet rich plasma.

Circular RNA expression pattern and competing endogenous RNA network involved in rotator cuff tendinopathy / 中国修复重建外科杂志

Objective: To detect the differentially expressed circular RNA (circRNA) in rotator cuff tendinopathy and analyze the potential molecular mechanism of these parental genes. Methods: Ten supraspinatus tendons donated from patients who underwent tendon repair surgery between June 2018 and June 2019 were used for RNA-sequence. All rotator cuff tendinopathy and normal tendon samples were confirmed by MRI, histological staining, and observation by arthroscopy. All pathological tendons were matched with tendon samples for patients' age, gender, body mass index, and Bonar score. The bioinformatic analysis was performed based on the differentially expressed circRNA and their parental genes, including gene ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and competing endogenous RNA (ceRNA) network construction. Results: There were 94 differentially expressed circRNAs, including 31 up-regulated and 63 down-regulated, detected between the rotator cuff tendinopathy and normal tendon samples with |log2 fold change (FC)| >2, P<0.05. GO analysis showed that the genes were mostly enriched in response to cyclic adenosine monophosphate (cAMP). KEGG pathway analysis showed that the most genes were enriched in extracellular matrix-receptor interaction, protein digestion and absorption, cell cycle, and nuclear factor κB signaling pathway. ceRNA networks showed the interactions among circRNAs, mRNAs, and miRNAs. And circRNA.8951-has-miR-6089-DNMT3B was the most sum max energy. Conclusion: This bioinformatic study reveals several potential therapeutic targets for rotator cuff tendinopathy, which paves the way to better treatment and prevention of this disorder.

Comparison of two surgical methods in the treatment of rotator cuff tendinopathy / 中国综合临床

Objective To compare the effect of whether rotator cuff pathological tissue cleaning and tendon insertion reconstruction or not under shoulder arthroscopy on the surgical treatment of rotator cuff tendinopathy. Methods From September 2015 to January 2017,the clinical data of forty-one patients with rotator cuff tendinopathy treated by surgical medicine ward in Shengjing Hospital of China Medical University were retrospectively analyzed. According to different surgical methods,41 patients were divided into A group and B group. In group A,21 patients were treated with shoulder arthroscopic bursa debridement combined with selective acromioplasty. In group B,20 patients were treated with cleanup of pathological changes tissue and reconstruction of tendon insertion on the basis of A. All patients were followed up for one year. Constant-Murley shoulder function score,visual analog scale (VAS),University of California Los Angeles (UCLA) and Hawkins sign,arc of pain sign and infraspinatus muscle test were used as the evaluation indexes. The shoulder joint function was evaluated so as to compare the efficacy of two surgical methods for rotator cuff disease. Results Compared with the preoperative,the postoperative VAS score,UCLA score and Constant-Murley score in both groups were significantly improved. In group A,the preoperative in group A (5. 0±1. 3) points,(15.5±1.4) points,(65.1±5.7) points) were increased to (0.7±0.4) points,(33.0±1.7) points,(90. 9±3. 1) points. The preoperative scores of group B were (5. 2±1. 0)points,(15. 6±2. 0) points, (65. 4±5. 9) points, and increased to ( 0. 4 ± 0. 5) points, ( 34. 3 ± 0. 9) points, ( 93. 3 ± 2. 3) points respectively,and the differences were statistically significant (group A: t＝14. 77,P＜0. 001; t＝－ 74. 44,P＜0. 001; t＝－ 29. 19,P＜0. 001; group B: t＝23. 13,P＜0. 001; t＝－ 61. 52,P＜0. 001; t＝－ 26. 38,P＜0. 001). The UCLA score and Constant-Murley score of shoulder joint in group B were higher than those in group A (t＝－3. 27,P＝0. 003; t＝－2. 90,P＝0. 007). Postoperative positive rates of Hawkins sign,pain arc sign and infraspinatus muscle test in group A decreased from 90%(18/20),90%(18/20),95%(19/20) to 15%( 3/20),10%( 2/20) and 15%( 3/20) respectively. There was a significant difference between preoperative and postoperative (χ2＝13. 067,P＜0. 001) . χ2＝14. 063,P＜0. 001; χ2＝14. 063,P＜0. 001), group B decreased from 90. 5%( 19/21), 85. 6%( 18/21), 90. 5%( 19/21) to 9. 5%( 2/21), 4. 8%(1/21),9.5%(2/21).There were significant differences between preoperative and postoperative (χ2＝15. 059,P＜0. 001;χ2＝12. 500,P＜0. 001;χ2＝15. 059,P＜0. 001) . Conclusion Both group A and group B are effective in the treatment of rotator cuff tendon disease,and group B is more effective than group A in the treatment of rotator cuff tendon disease.

Predictors of shoulder degeneration in the Kwazulu-Natal population of South Africa / Indicadores de la degeneración del hombro en la poblacion Kwazulu/Natal de Sudáfrica

SUMMARY: The critical shoulder angle and acromion index are conventional radiological tools employed as predictors of shoulder degeneration. As they represent the static components of glenohumeral stability, the scapulo-humeral geometry and underlying subacromial tissue appear as the resultant cause-effect factors. Consequently, the purpose of this study was to investigate the critical shoulder angle and acromion index as interrelated parameters within the South African population. The measurement of both biomechanical parameters was conducted on two-hundred and sixty (n = 260) true AP radiographs. This was a cross-sectional study that also incorporated the demographic representation of the population group which was analysed accordingly. The mean values recorded for both the critical shoulder angle (36.31±5.84º) and acromion index (0.74±0.13) suggested rotator cuff arthropathy. The results confirmed the theories of Nyffeler et al. (2006) and Moor et al. (2012) who alluded to glenoid inclination and the acromial coverage over the humeral head. A significant proportionality correlation, verified by a P value of 0.000, was established between the acromion index and critical shoulder angle which may assist to differentiate between normal asymptomatic shoulders and those with cuff disease. Furthermore, these predictors of shoulder degeneration may present as a preventative tool against tear progression.

RESUMEN: El ángulo crítico del hombro y el índice acromial son herramientas radiológicas convencionales empleadas como indicadores de la degeneración del hombro. Debido a que representan los componentes estáticos de la estabilidad glenohumeral, la geometría escápulo-humeral y el tejido subacromial subyacente aparecen como los factores causa-efecto resultantes. En consecuencia, el propósito de este estudio fue investigar el ángulo crítico del hombro y el índice acromial como parámetros interrelacionados dentro de la población sudafricana. La medición de ambos parámetros biomecánicos se realizó en 260 radiografías antero-posteriores (AP). Se realizó un estudio transversal que también incorporó la representación demográfica del grupo de la población que fue analizada. Los valores medios registrados tanto para el ángulo crítico del hombro (36,31 ± 5,84º) como para el índice del acromión (0,74 ± 0,13) sugirieron una artropatía del manguito rotador. Los resultados confirmaron las teorías de Nyffeler et al. (2006) y Moor et al. (2012) que aludían a la inclinación glenoide y a la cobertura acromial sobre la cabeza humeral. Se estableció una correlación de proporcionalidad significativa, verificada por un valor de P de 0,000, entre el índice acromial y el ángulo crítico del hombro, lo que puede ayudar a diferenciar entre los hombros asintomáticos normales y aquellos con enfermedad del manguito rotador. Además, estos predictores de degeneración del hombro pueden ser útiles como una herramienta preventiva contra la progresión del desgarro.

Eficacia de la terapia de ondas de choque como alternativa de tratamiento en lesiones del manguito rotador / Effectiveness of shock wave therapy as an alternative to the rotator cuff injury treatment

Las lesiones del manguito rotador resultan motivo de consulta frecuente en pacientes mayores. La mayoría de las veces no existen antecedentes traumáticos agudos generando limitación progresiva en actividades la vida diaria (AVD). El objetivo de este estudio es mostrar resultados en tendinosis del manguito rotador, en pacientes tratados con terapia de ondas de choque extracorpóreas (TOCE). Se realiza un estudio observacional descriptivo prospectivo en el cual presentan resultados clínicos y funcionales en pacientes con lesión descrita, tratados con TOCE con pobre respuesta a tratamientos convencionales y cuadros clínicos de larga data mediante la aplicación de Escala Visual Análoga (EVA) del dolor y valoración del rango de movilidad. La mayor presencia de lesión se presentó en mujeres 63.6%. El hombro mayormente afectado fue derecho en un 63.6%. Se encontró cambios significativos en EVA pre y post tratamiento con medias de 7.9 y 0.5 respectivamente y diferencia estadística p<0.001. Igualmente se evidenció diferencia estadísticamente significativa de los diferentes rangos de movimiento pre y post tratamiento p<0.001. Se concluye que la TOCE es un método eficaz en el tratamiento de las tendinosis del manguito rotador con alivio del dolor y retorno a niveles funcionales.

Rotator cuff injuries are reason for consultation frequent in elderly patients. Most of the time there are no background traumatic acute generating progressive limitations in activities of daily living (ADLS). The objective of this study is to show results in tendonitis of the rotator cuff, in patients treated with extracorporeal shock wave therapy (ESWT). It is a prospective descriptive observational study which presents clinical and functional outcomes in patients with described lesion, treated with ESWT with poor response to conventional treatments and clinical pictures of longstanding through implementing visual analog scale (VAS) of pain and evaluation of range of motion. The greater presence of lesion is present in women 63.6%. Mostly affected shoulder was right in a 63.6%. Found significant changes in VAS pre and post treatment with averages of 7.9 and 0.5 respectively and different statistical p < 0.001. We were conclude that the ESWT is an effective method in the treatment of the tendonitis of the rotator cuff with relief from pain and return to functional levels.

Shoulder Disease Patterns of the Wheelchair Athletes of Table-Tennis and Archery: A Pilot Study

OBJECTIVE: To investigate the shoulder disease patterns for the table-tennis (TT) and archery (AR) wheelchair athletes via ultrasonographic evaluations. METHODS: A total of 35 wheelchair athletes were enrolled, made up of groups of TT (n=19) and AR (n=16) athletes. They were all paraplegic patients and were investigated for their wheelchair usage duration, careers as sports players, weekly training times, the Wheelchair User's Shoulder Pain Index (WUSPI) scores and ultrasonographic evaluation. Shoulders were divided into playing arm of TT, non-playing arm of TT, bow-arm of AR, and draw arm of AR athletes. Shoulder diseases were classified into five entities of subscapularis tendinopathy, supraspinatus tendinopathy, infraspinatus tendinopathy, biceps long head tendinopathy, and subacromial-subdeltoid bursitis. The pattern of shoulder diseases were compared between the two groups using the Mann-Whitney and the chi-square tests RESULTS: WSUPI did not significantly correlate with age, wheelchair usage duration, career as players or weekly training times for all the wheelchair athletes. For the non-playing arm of TT athletes, there was a high percentage of subscapularis (45.5%) and supraspinatus (40.9%) tendinopathy. The percentage of subacromial-subdeltoid bursitis showed a tendency to be present in the playing arm of TT athletes (20.0%) compared with their non-playing arm (4.5%), even though this was not statistically significant. Biceps long head tendinopathy was the most common disease of the shoulder in the draw arm of AR athletes, and the difference was significant when compared to the non-playing arm of TT athletes (p<0.05). CONCLUSION: There was a high percentage of subscapularis and supraspinatus tendinopathy cases for the non-playing arm of TT wheelchair athletes, and a high percentage of biceps long head tendinopathy for the draw arm for the AR wheelchair athletes. Consideration of the biomechanical properties of each sport may be needed to tailor specific training for wheelchair athletes.