Cuff tear arthropathy in the nineteenth century: 'chronic rheumatic arthritis' with 'partial luxation upwards' of the humeral head.

INTRODUCTION: Cuff tear arthropathy of the shoulder is a common indication for insertion of an increasing number of reverse shoulder arthroplasties. It is widely believed that this condition was unknown to medical practitioners and writers prior to the introduction of the term cuff tear arthropathy by Charles Neer in 1977. PURPOSE: To search nineteenth-century written sources for pathoanatomical and biomechanical descriptions of the typical changes found in cuff tear arthropathy. METHODS: A historical review. Nineteenth-century medical textbooks, reviews, case series, autopsy reports and illustrations were systematically searched and retrieved for relevance. References were hand-searched. Illustrations were reproduced and interpreted. RESULTS: A richly illustrated nineteenth-century literature was identified. The typical changes in cuff tear arthropathy were termed 'chronic rheumatic arthritis' of the shoulder with 'partial luxation upwards' of the humeral head and interpreted within a pathoanatomical and biomechanical framework. Detailed descriptions and illustrations of massive rotator cuff tears, biceps pathology and the osseous changes were identified and presented. CONCLUSION: The pathoanatomical and biomechanical changes later termed cuff tear arthropathy were well understood and nicely described in nineteenth-century medical literature.

Humeral head histopathological changes in cuff tear arthropathy.

PURPOSE: The aim of this study was to investigate the histopathological changes in the humeral head in cuff tear arthropathy (CTA) compared with those in glenohumeral osteoarthritis (OA) and humeral neck fracture, which served as non-cuff tear controls. METHODS: Twenty-three humeral heads extracted at the time of shoulder prosthesis arthroplasty between June 2014 and July 2015 were evaluated in the present study. The diagnoses included four-part humeral neck fracture ( n = 4; average age, 85.0 years), glenohumeral OA ( n = 4; average age, 71.0 years), and CTA ( n = 15; average age, 73.0 years). The humeral heads were evaluated pathologically by hematoxylin and eosin and Safranin-O staining, and the thickness of the articular cartilage was measured. RESULTS: Fibrillation, thinning, and tearing of the cartilage were observed in the superior area of the humeral heads in CTA and glenohumeral OA. In CTA cases, clusters of chondrocytes in the cartilage were observed. Moreover, the thickness of the cartilage layer in the middle of the humeral head was 1.54 ± 0.07, 0.32 ± 0.46, and 2.19 ± 0.50 mm in humeral neck fracture, glenohumeral OA, and CTA, respectively. The cartilage layer in CTA was thicker than that in glenohumeral OA (CTA vs. OA: p < 0.05). CONCLUSION: OA changes in the superior area of the humeral heads and thickening of the cartilage layer from the middle to the inferior of the humeral heads were confirmed histopathologically, suggesting that simultaneous mechanical and nutritional factors might be contributing to CTA pathogenesis. The current study provided the better understanding of cartilage damage and thickening in CTA. This will help guide treatment options in the setting of CTA.

Shoulder Lesion in a 69 Year Old Woman.

Milwaukee Shoulder Syndrome (MSS) is a painful progressive arthropathy in which hydroxyapatite crystal deposition in synovial tissue induces lysosomal release of collagenase and neutral proteases. These enzymes are destructive to periarticular tissue, including the synovium, articular cartilage, rotator cuff muscles, and the intrasynovial cortical bone. MSS predominantly occurring in women (90%) over the age of 70 years of age with a clinical history marked by recurrent joint effusions and pain, which classically worsens at night. Our patient is a 69-year-old woman who presented with progressive shoulder pain, most prominent at night, with limited range of motion and swelling; intermittent discharge; and intermittent neck pain that radiated to her right upper extremity. Her medical history was notable for invasive carcinoma of the right breast treated with mastectomy and radiation. She was also treated with radiation therapy for right shoulder pain and a lucent right shoulder lesion presumed to be metastatic breast cancer. The remainder of her medical history consists of hypertension, diabetes mellitus, hyperlipidemia, and uneventful bilateral total knee arthroplasties. At presentation, she denied constitutional symptoms. Based on the patient's history and physical exam the differential diagnosis included primary and metastatic malignancy, radiation induced sarcoma and necrosis, infection, Charcot disease, and crystal arthropathies. Physical exam, laboratory findings, and imaging studies led us to the diagnosis of MSS.

Use of platelet-rich plasma in the treatment of rotator cuff pathology. What has been scientifically proven? / Utilización del plasma rico en plaquetas en el tratamiento de la patología del manguito de los rotadores. ¿Qué hay demostrado científicamente?

PURPOSE: To analyze the current scientific and/or clinical evidence supporting the use of platelet-rich plasma (PRP) in the treatment of rotator cuff pathology. METHODS: After a systematic review in PubMed, studies assessing PRP efficacy in the treatment of rotator cuff pathology published since 2013 to date were identified. Data were grouped based on type of study (laboratory, clinical or meta-analysis); accordingly study design, pathology treated and clinical outcomes were summarized. RESULTS: Thirty five articles have been analyzed: 10 laboratory studies, 17 clinical assays and 8 meta-analyses. While laboratory studies report positive or partially positive results for the use of PRP, 70.6% of clinical studies and 75% of meta-analysis found no statistically significant differences between the PRP group and the control group. DISCUSSION: The positive results of laboratory studies do not translate well to clinical practice. There is no concordance among the few positive results reported in the clinical studies, and even some contradictory effects have been reported. CONCLUSIONS: There is no solid scientific and/or clinical evidence supporting the use of PRP in the treatment of rotator cuff pathology in routine clinical practice.