Rotator Cuff in Asymptomatic Volunteers: Contrast-enhanced US Depiction of Intratendinous and Peritendinous Vascularity
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Chronic rotator cuff tendinopathy and tearing have been associated with extrinsic subacromial impingement and intrinsic degenerative changes, among other factors. These other factors include both intrinsic bio- logic factors, such as the role of matrix metalloproteinase expression, and morphologic factors, such as tendon vascularity. The hypothesis that there is an association between rotator cuff disease and tendon vascularity is based on the results of cadaveric studies that have demonstrated a region of hypovascularity at the articular surface of the distal aspect of the supraspinatus tendon, or the so-called critical zone. The age-dependent alterations that occur in the blood supply to the rotator cuff and the role of this supply in the origin of rotator cuff disease have not been definitively established in vivo. A study involving the use of orthogonal polarization microscopy at arthroscopy revealed a significant decrease in the microcirculation adjacent to rotator cuff lesions.
The potential role of vascularity in the pathogenesis of rotator cuff tendinopathy requires further study, as it may have important implications for understanding the natural history of the disease and the development and application of surgical and biologic interventions. Methods currently used to image the rotator cuff in vivo include magnetic resonance (MR) and ultrasonography (US); however, methods of looking specifically at the microcirculation have been limited. Before now, to our knowledge, there was no diagnostic modality with the capability to noninvasively and reliably depict the vascular anatomy of the rotator cuff dynamically in vivo in asymptomatic individuals. This study was designed to test the hypothesis that regional variations in supraspinatus tendon vascularity exist and can be imaged and quantified with contrast material– enhanced US in asymptomatic individuals.
Full Article: Rotator Cuff in Asymptomatic Volunteers: Contrast-enhanced US Depiction of Intratendinous and Peritendinous Vascularity
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