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Title: The pathology of rotator cuff failure
Author: Benson, Richard
Awarding Body: University of London
Current Institution: University of London
Date of Award: 2009
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Abstract The thesis has two aims. Firstly, to gain a greater understanding of the intrinsic mechanisms involved in rotator cuff pathology and its progression. Secondly, to investigate how outcome after operative intervention may be influenced by the macroscopic and microscopic appearance of the rotator cuff. It has been hypothesis that rotator cuff disease is part of a continuum from impingement, through partial thickness tear and leading to massive rotator cuff tears. The thesis uses this hypothesis to create a model of the stages of rotator cuff failure using the macroscopic appearance of the rotator cuff. Biopsies were taken from in vivo human rotator cuffs at different stages of the model, and investigated for evidence of a pathological failure cascade. Initially hypoxia and apoptosis were investigated as both had been previously identified as important factors in rotator cuff disease aetiology. Biopsies were analysed using immunhistochemical techniques: TUNEL (a marker for apoptosis) and BNIP-3 (a marker for hypoxia). Both demonstrated increased expression with worsening rotator cuff disease. Therefore, apoptosis appears to increase as the disease progresses and a hypoxic mechanism is implicated. A second study analysed the healing response of the rotator cuff using markers of tendon healing, VEGF( a marker of vascular remodelling) and TSG-6 (a marker of inflammation). They showed evidence of a reduced healing response in large and massive tear groups compared with controls and tendon in earlier disease. In a third clinical study, patients without full thickness tears undergoing subacromial decompression were followed up with Oxford Shoulder Score and the predictive value of the macroscopic and microscopic appearances of the bursa, coracoacromial arch and rotator cuff tendons were assessed. Biopsy samples of bursa and coracoacromial ligament were analysed using basic histological and immunohistochemical techniques. All patients showed statistically significant improvement in OSS but patients with partial tears and hooked acromion did significantly worse. The microscopic appearance did not predict outcome.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available