More histologic and ultrastructural degenerative signs in the subscapularis tendon and the joint capsule in male patients with shoulder impingement

Abstract

PurposeThe purpose of the present study was to analyze biopsy samples from the subscapularis tendon and from the joint capsule from male patients with shoulder impingement syndrome (SAIS) and compare them with samples from male patients with post-traumatic recurrent shoulder instability. The hypothesis of the study was that patients with SAIS would have more histologic and ultrastructural degenerative changes in their subscapularis tendon and joint capsule than patients with post-traumatic recurrent shoulder instability.MethodsMale patients scheduled for surgery, with either subacromial decompression or Bankart reconstruction, were included. Four biopsies from each patient were obtained from the capsule and four from the subscapularis tendon during arthroscopic surgery. The histologic characteristics and the presence of glycosaminoglycans were assessed using the light microscope, and the ultrastructure was assessed using a transmission electron microscope.ResultsEight patients, median age 53 (45–74) years (p < 0.0001), were included in the impingement group, and 12 patients, median age 27 (22–48) years, were included in the instability group. The histologic assessment revealed significantly higher cellularity and total degeneration score in the capsule (p = 0.016 and p = 0.014 respectively) in patients with subacromial impingement compared with the instability patients. The corresponding finding was not made for the subscapularis tendon. The ultrastructural evaluation revealed that the instability patients had more fibrils with a large diameter (indicating less degeneration) in both the subscapularis tendon and the capsule compared with the impingement patients (p < 0.0001).ConclusionMale patients with subacromial impingement have more histologic and ultrastructural degenerative changes in their shoulder compared with patients with post-traumatic recurrent shoulder instability.Clinical relevanceIt appears that in patients with subacromial impingement, the whole shoulder joint is affected and not only the subacromial space. It is the opinion of the authors that intra-articular therapeutic injections could be tried more often in these patients.Level of evidenceIII.

No significant histological or ultrastructural tendinosis changes in the hamstring tendon in patients with mild to moderate osteoarthritis of the knee?

“…The strengths of the study include the fact that the biopsies were obtained from living humans and that efforts were made to reduce the inherent age difference between the study groups. The age difference was inevitable, but the fact that age has not been shown to be a source of bias when comparing fibril diameters in both the hip and the shoulder in previous publications must be taken into account [ 8 , 15 ]. Furthermore, Gagliano et al have shown that the morphological and molecular characteristics of the hamstrings tendon were not influenced by age [ 9 ].…”

“…Each element can obtain between 0 and 3 points. This procedure and evaluation system have been performed in multiple previous studies [ 3 , 8 , 15 , 25 , 26 ].…”

Comparative Study of Validity and Reliability of Two Handgrip Dynamometers: K-Force Grip and Jamar

“…Participants of the pain group were volunteers recruited during their visit to a medical center. Participation had to meet the following criteria: (i) Presence of shoulder pain and painful arc for 15 days up to three months (subacute stage), as longer duration is expected to have degenerative changes [19], (ii) impingement syndrome after physical examination at the site of treatment with musculoskeletal ultrasound (Sonoline G20), (iii) diagnosis of impingement syndrome and not joint arthritis (AC, Shoulder), (iv) clinical signs of nerve pressure or any red flag of other pathology, (v) no sign of neurological deficit, spine trauma, or surgery to the cervical or shoulder area, (vi) absence of rheumatic or infectious diseases, psychiatric or cancer history, metabolic diseases (diabetes or thyroid), coagulopathies or use of anticoagulants, and neuromuscular degenerative diseases, and (vii) presence of painful arc on the movement of the shoulder and to be positive for an anterior slide test, apprehension test, and Hawkin's test or impingement sign [20]. Patients had a different clinical picture, but they all had to have pain on the suprascapular tendon and a positive sign on the supraspinatus tendon.…”

Validation of Three Different Sterilization Methods of Tilapia Skin Dressing: Impact on Microbiological Enumeration and Collagen Content

“…Afterwards, the slides were examined microscopically and the histological evaluation was performed in a blind fashion on coded samples, and a comparison was made with the sections from the control-treated group. Histological evaluation to assess integrity and organization of collagen fibers was based on 0–3 scale ( 35 , 36 ). Collagen integrity scores: 0 = continue, long fiber, 1 = slightly fragmented, 2 = moderately fragmented, 3 = severely fragmented.…”