Rotator cuff disorder. A new approach to the management of impingement and rotator cuff lesion
Rotator cuff related disorders are among the top causes of ill health. The present study investigates inflammatory processes going on in rotator cuff tissues, rotator cuff muscle function and contractility in order to improve treatment and rehabilitation. Furthermore health related concerns of patient suffering from rotator cuff disorder, as well as the concerns of health professionals in relation to communication and clinical decision making will be characterized.
Rotator cuff (RC) related shoulder disorders are among the top causes of ill health with a prevalence of 2-8%. RC tears are one of the most common musculoskeletal complaints and a substantial source of morbidity, especially in elderly patients. Treatment success is an important operational indicator in the framework action plan (National Clinical Guideline - NKR) to treat RC pathology in Denmark.
RC function is an important determinant of the prognosis after non-surgical treatment as well as after surgical repair. So far, main focus has been on tendon healing, whereas there are only a few published papers on the function of the accompanying diseased RC muscles, which not only generate movement, but also provide important shoulder joint stability.
RC impingement and RC lesion, particularly of the supraspinatus (SS) tendon, are the most frequent clinical problems. Despite some biological healing, persistent problems include poor functional outcomes due to chronic pain and high re-tear rates complicate surgical repair. The result is atrophy of the dynamic tissues. Superior excursion of the humeral head is frequently seen with cuff tears, making arm elevation possible only through scapula-thoracic motion while gleno-humeral motion is diminished. This condition is known as cuff arthropathy (arthrosis) and has great significance because of its devastating effect on life quality. These patients often require prosthetic replacement.of the reverse type (RSA prosthesis). Replacement surgery is particularly complicated because of concomitant arthritis-related bone loss. An early and correct diagnosis with proper assessment of the inflammatory processes and inflammatory patterns taking place in the tissues in and about the RC is therefore of paramount importance to all patients.
A thorough quantitative assessment of the RC function using different imaging techniques is also needed in order to treat and to prevent rotator cuff diseases from escalating. Magnetic resonance imaging (MRI) provides important static information on muscle atrophy and fatty infiltration. Fatty infiltration of muscle bellies is an important prognostic factor in RC tears. It was described initially in computed tomography (CT) examinations but recent data found solid correlations for application of Goutallier's classification scheme to MRI.
Contractility within individual muscles in various RC injuries and diseases has, however, so far only been studied in animal models. Ultrasound speckle tracking (UST) allows for an objective and quantitative evaluation of regional muscle function. This non-invasive ultrasound modality has the potential to track muscle function: i.e. muscle contractility and to monitor treatment response in different RC diseases (Frich et al., unpublished).
This protocol is designed to study RC disease and cuff arthropathy. User involvement in research is necessary for developing design and research questions. In parallel, we therefore, in a separate study, aim to qualitatively characterize health-related concerns of patients suffering from RC disorders, as well as the concerns of health professionals in relation to communication and clinical decision-making.
Description of the cohort
Patient cohort includes 100 patients treated at the Department of Orthopeadic Surgery, Odense University Hospital due to rotator cuff disease
Data and biological material
For investigation of inflammatory profiles bursae, tendon and muscle biopsies from diseased rotator cuff tissue, in addition to blood samples will be collected.
Different imaging modalities are used to quantify muscle atrophy, fatty infiltration and muscle contractility.
Structured interviews of patient with shoulder trouble and health professionals are used to gather ethnographic data.
Collaborating researchers and departments
Department of Pathology, Clinical Institute of Research, University of Southern Denmark
- Professor Henrik Daa Schrøder, DMSc
Department of Cardiology, Odense University Hospital
- Associate professor Jordi dahl, MD, PhD
Department of Radiology, Odense University Hospital
- Consultant John Hjarbæk MD
Department of Orthopaedic Surgery, Odense University Hospital
- Associate Professor Anders Holstgaaard, PhD
- Associate Professor Lars Henrik Frich, MD, PhD
Department of Health Science and Technology, Aarhus University Hospital
- Associate Professor Allan Stensballe, PhD
Department of Public Health, University of Southern Denmark
- Associate professor Lotte Huniche, PhD
Department of Neurobiology Research, IMM, SDU and Department of Neurology, Odense University Hospital
- Associate professor Kate Lykke Lambertsen, PhD