Tendon degeneration and stages of rotator cuff disease
Rotator cuff disease can be divided into 3 stages. The first stage includes subacromial impingement syndrome, bursitis or a tendinopathy. The next stage is a partial rotator cuff tear. The last stage is a full thickness rotator cuff tear, which can progress to a rotator cuff arthropathy.
The causes of rotator cuff disease have not been determined; one of the hypotheses is that a combination of intrinsic and extrinsic factors may be the cause. Sometimes the cause can be traumatic, however in elderly people this is not necessarily the case.
There are various treatment options such as surgery, physiotherapy and glucocorticoid injections. It has been thought that treatment are less successful if the cause of the rotator cuff disease is not established. The aim of this study was to investigate changes of tendon degeneration in relation with the stages of rotator cuff disease.
The results show that the tendon fibre structure changes in all stages of the rotator cuff disease. The partial and full rotator cuff tear show a loss in fine fibre structure, fewer and rounded nuclei, increased cellularity and vascularity. The results also showed a decrease in collagen stainability after a tear. A full rotator cuff tear also showed a hyalinization.
The most important finding of this study is that tendon degeneration significantly increases as the tendon deteriorates. More degenerative changes were found in stage 2 and 3 of the rotator cuff disease. The treatment should focus on improving the function of the shoulder and depending on the stage, there are various treatment options such as exercises or surgical treatment.
> From: Jo et al., Knee Surg Sports Traumatol Arthrosc (2017) (Epub ahead of print). All rights reserved to European Society of Sports Traumatology, Knee Surgery, Arthroscopy. Click here for the online summary.