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MR Imaging of the rotator cuff with calcifying tendinitis
Abstracts $27
J. Shoulder Elbow Surg. Volume 5, Number 2, Part 2
46
47
MR Imaging of the rotator cuffwith calcifying tendinitis. Loew, M., Sabo, D., Mau, H., Perlick, L., Wehrle, M. An analysis of the MR-images of 75 patients with calcifying tendinitis of the shoulder was performed. The aim of the study was to recognize characteristic findings of the calcific deposits and their relation to the involved tendons as well as the coincidence with additional degenerative alterations of the rotator cuff The calcifications can be demonstrated with high accuracy (> 95 %) in Tl-weighted images as areas of decreased signal intensity. It is possible to characterize the calcifications similar to common radiologic classifications differentiating form and density of the caicific deposits as well as their delimitation to the tendon structure: Type I - compact and homogeneous one-part structure; well defined borders Type It - subdivided homogeneous structure;weU defined borders Type III- diffuse area of low signal intensity; no defined borders to the tendon. In T2-images there frequently is a perifocal band of increased signal intensity which can be identified as an oedema around the calcification. Analysing two perpendicular planes the calcifications can be assigned to the corresponding anatomical structure. 83 percent were located in the supraspinatus tendon above the humeral head or in the superior part of the subscapularis tendon. Degenerative areas of the rotator cuff are demonstrated as small zones of increased signal intensity, abnormal morphology or discontinuity of the tendon. Only in one patient a partial tear could be found; 11 percent showed variable signs of degenerative alteration of the involved tendon.
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SENSORY NERVE ENDINGS IN THE ROTATOR CUFF OF THE SHOULDER. F. Odella, M.D. & R. Leo, M.D., & A. Parafioriti* M.D., 3th Dept. of Orthopaedic Surgery, * Dept. of Surgical Pathology, Orthopaedic Institute "Gaetano Pini", Milan, Italy. In this study we researched the presence of nerve endings at the tendinous portion of the rotator cuff of the shoulder. 40 biopsies were taken from 40 patients, subjected to acromioplasty and tenorraphy of the rotator cuff; the biopsies themselves were principally taken from the supraspinatus tendon and/or from the infraspinatus tendon. The biopsies to be examined were fixed in a 10% formalin solution, embedded in paraffin and, subsequently, coloured with hemathoxUin-eosin. We then used an immunohistochemical stain, specifically for the nerve structures, S-100 stain. With the hemathoxylin-eosin it became evident that the tendinous fibres of the rotator cuff were composed, in 90% of the cases, of dense connective tissue. The frequent observation of neovasculadzation phenomena, in 85% of the cases, indicated that the organism has a noticable tendency to attempt a repair of tendinous lesions thus produced. Trough S-100 stain, over 55% of the sampte evaluated, demonstrated the presence of nervous structures, attributable to fine, isolated nervous fibres or free nerve endings. The study demonstrated, therefore, an abundant presence of nerves in the tendons of the rotator cuff. The presence of nervous structures in the tendons of the rotator.cuff permits us to think that their alteration can cause scarse quality control of the movement of the shoulder joint by the cortical, and subcortical nervous structures. Such a functional alteration in shoulder movement could contribute to the starting of an impingement syndrome, or an atraumatic instability.
IMPORTANCE OF VASCULARITY IN CELL PROLIFERATION AND COLLAGEN PRODUCTION IN TORN ROTATOR CUFF. J.Kumagai, MD, K.SATO,MD, T.SAWAI,~D~, H.Sano,MD, S.Kokubun,MD. and M.Sakurai,MD. Dept of Orthop.Surg.& ~SPathology, Tohoku Univ.Sch.of Med.,Sendai,Japan. The past histologic studies showed the possibility of repair potentials in rotator cuff tears. The present study was undertaken to elucidate the relations between actively proliferating cells and collagen productions at the torn cuffs. The entire medial margins of torn cuffs were obtained from 70 cases, aged from 27 to 73 (58 in average) with 58 complete and 12 incomplete tears. Paraffin embedded specimens were stained with antibodies against proliferating cell nuclear antigen (PCNA) and Ulex europaeus lectin (UEA-I) for detecting vessels. The productions of the major component of the tendon were detected as m-RNA of procollagen type I~i, utilizing in situ hybridization technique. In the complete tears the stumps were covered with the proliferating cells, while incomplete tears had variety of findings: cell activity was less dominant in articular side or intratendinous tears. PCNA positive cells were vascular cells, fihroblasts with plump nuclei adjacent to vessels particularly at the subbursal layer or those at the tendon proper in the surgical margins. The cells covering the stumps were not stained consistently. Signals of m-RNA of procollagen type I were found predominantly in the fibroblasts adjacent to the vessels and vascular cells. These results demonstrate the close relation of the presence of vessels and new collagen productions especially at the subbursal layer, which would be important in the repair process of the torn cuffs.
49
THE INCIDENCE OF SPECIFIC DEGENERATIVE CHANGES AT THE INSERTION OF THREE CUFF TENDONS. H. Ishii, MD, H.K. Uhthoff, MD, M.Sakurai, MD. Orthopaedics Research, Univ. of Ottawa. Tendon of supraspinatus (Ssp) ruptures more often than that of Infraspinatus (lsp) + subscapularis (Sse). Differences in histologically visible structures must exist to explain these facts, especially at the insertion where most tears happen. Objectives of this study is to find out whether a difference in tendon structure could explain the prevalence of cuff tears in the Ssp. METHODS. 13 shoulders, 9 men and 4 women, aged from 32 91 years were obtained from 7 autopsies. H&E stain was performed, and each specimen was examined histologically for incidence of degeneration namely presence of calcification (C), granulation tissue(G)+ disruption of blue line (B), discontinuity of tendon fascicles (D), wide sulcus (W), partial tear (T), focal necrosis (F) at the insertion of bursal half and articular half of Ssc, Ssp and Isp. DISCUSSION. Tears happen generally in Ssp, and articular side tears are more frequent than bursal side tears. Therefore, pre-tear changes should occur more often in the articular half of the Ssp. The incidence of F and B were highest in articular half of Ssp in our series. On the other hand, most changes indicating partial tears (T,W) were seen in articular half of lsp and Ssc. The depth of these changes was the most important difference between the two. F & B extended through the entire depth of articular half mostly of Ssp, whereas T & W were limited to the subsynovial layer of the articular half, the remainiug part of the articular half being normal. CONCLUSION. Among signs of degeneration, F & B seem to be the most important evidence of progressive changes, as their incidence was highest in the articular half of the Ssp . T & W on the other hand were limited in depth.
J. Shoulder Elbow Surg. Volume 5, Number 2, Part 2
46
47
MR Imaging of the rotator cuffwith calcifying tendinitis. Loew, M., Sabo, D., Mau, H., Perlick, L., Wehrle, M. An analysis of the MR-images of 75 patients with calcifying tendinitis of the shoulder was performed. The aim of the study was to recognize characteristic findings of the calcific deposits and their relation to the involved tendons as well as the coincidence with additional degenerative alterations of the rotator cuff The calcifications can be demonstrated with high accuracy (> 95 %) in Tl-weighted images as areas of decreased signal intensity. It is possible to characterize the calcifications similar to common radiologic classifications differentiating form and density of the caicific deposits as well as their delimitation to the tendon structure: Type I - compact and homogeneous one-part structure; well defined borders Type It - subdivided homogeneous structure;weU defined borders Type III- diffuse area of low signal intensity; no defined borders to the tendon. In T2-images there frequently is a perifocal band of increased signal intensity which can be identified as an oedema around the calcification. Analysing two perpendicular planes the calcifications can be assigned to the corresponding anatomical structure. 83 percent were located in the supraspinatus tendon above the humeral head or in the superior part of the subscapularis tendon. Degenerative areas of the rotator cuff are demonstrated as small zones of increased signal intensity, abnormal morphology or discontinuity of the tendon. Only in one patient a partial tear could be found; 11 percent showed variable signs of degenerative alteration of the involved tendon.
48
SENSORY NERVE ENDINGS IN THE ROTATOR CUFF OF THE SHOULDER. F. Odella, M.D. & R. Leo, M.D., & A. Parafioriti* M.D., 3th Dept. of Orthopaedic Surgery, * Dept. of Surgical Pathology, Orthopaedic Institute "Gaetano Pini", Milan, Italy. In this study we researched the presence of nerve endings at the tendinous portion of the rotator cuff of the shoulder. 40 biopsies were taken from 40 patients, subjected to acromioplasty and tenorraphy of the rotator cuff; the biopsies themselves were principally taken from the supraspinatus tendon and/or from the infraspinatus tendon. The biopsies to be examined were fixed in a 10% formalin solution, embedded in paraffin and, subsequently, coloured with hemathoxUin-eosin. We then used an immunohistochemical stain, specifically for the nerve structures, S-100 stain. With the hemathoxylin-eosin it became evident that the tendinous fibres of the rotator cuff were composed, in 90% of the cases, of dense connective tissue. The frequent observation of neovasculadzation phenomena, in 85% of the cases, indicated that the organism has a noticable tendency to attempt a repair of tendinous lesions thus produced. Trough S-100 stain, over 55% of the sampte evaluated, demonstrated the presence of nervous structures, attributable to fine, isolated nervous fibres or free nerve endings. The study demonstrated, therefore, an abundant presence of nerves in the tendons of the rotator cuff. The presence of nervous structures in the tendons of the rotator.cuff permits us to think that their alteration can cause scarse quality control of the movement of the shoulder joint by the cortical, and subcortical nervous structures. Such a functional alteration in shoulder movement could contribute to the starting of an impingement syndrome, or an atraumatic instability.
IMPORTANCE OF VASCULARITY IN CELL PROLIFERATION AND COLLAGEN PRODUCTION IN TORN ROTATOR CUFF. J.Kumagai, MD, K.SATO,MD, T.SAWAI,~D~, H.Sano,MD, S.Kokubun,MD. and M.Sakurai,MD. Dept of Orthop.Surg.& ~SPathology, Tohoku Univ.Sch.of Med.,Sendai,Japan. The past histologic studies showed the possibility of repair potentials in rotator cuff tears. The present study was undertaken to elucidate the relations between actively proliferating cells and collagen productions at the torn cuffs. The entire medial margins of torn cuffs were obtained from 70 cases, aged from 27 to 73 (58 in average) with 58 complete and 12 incomplete tears. Paraffin embedded specimens were stained with antibodies against proliferating cell nuclear antigen (PCNA) and Ulex europaeus lectin (UEA-I) for detecting vessels. The productions of the major component of the tendon were detected as m-RNA of procollagen type I~i, utilizing in situ hybridization technique. In the complete tears the stumps were covered with the proliferating cells, while incomplete tears had variety of findings: cell activity was less dominant in articular side or intratendinous tears. PCNA positive cells were vascular cells, fihroblasts with plump nuclei adjacent to vessels particularly at the subbursal layer or those at the tendon proper in the surgical margins. The cells covering the stumps were not stained consistently. Signals of m-RNA of procollagen type I were found predominantly in the fibroblasts adjacent to the vessels and vascular cells. These results demonstrate the close relation of the presence of vessels and new collagen productions especially at the subbursal layer, which would be important in the repair process of the torn cuffs.
49
THE INCIDENCE OF SPECIFIC DEGENERATIVE CHANGES AT THE INSERTION OF THREE CUFF TENDONS. H. Ishii, MD, H.K. Uhthoff, MD, M.Sakurai, MD. Orthopaedics Research, Univ. of Ottawa. Tendon of supraspinatus (Ssp) ruptures more often than that of Infraspinatus (lsp) + subscapularis (Sse). Differences in histologically visible structures must exist to explain these facts, especially at the insertion where most tears happen. Objectives of this study is to find out whether a difference in tendon structure could explain the prevalence of cuff tears in the Ssp. METHODS. 13 shoulders, 9 men and 4 women, aged from 32 91 years were obtained from 7 autopsies. H&E stain was performed, and each specimen was examined histologically for incidence of degeneration namely presence of calcification (C), granulation tissue(G)+ disruption of blue line (B), discontinuity of tendon fascicles (D), wide sulcus (W), partial tear (T), focal necrosis (F) at the insertion of bursal half and articular half of Ssc, Ssp and Isp. DISCUSSION. Tears happen generally in Ssp, and articular side tears are more frequent than bursal side tears. Therefore, pre-tear changes should occur more often in the articular half of the Ssp. The incidence of F and B were highest in articular half of Ssp in our series. On the other hand, most changes indicating partial tears (T,W) were seen in articular half of lsp and Ssc. The depth of these changes was the most important difference between the two. F & B extended through the entire depth of articular half mostly of Ssp, whereas T & W were limited to the subsynovial layer of the articular half, the remainiug part of the articular half being normal. CONCLUSION. Among signs of degeneration, F & B seem to be the most important evidence of progressive changes, as their incidence was highest in the articular half of the Ssp . T & W on the other hand were limited in depth.