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Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.  Labels: OBJECTIVE, METHODS, METHODS, RESULTS. Meshes: Adrenal Cortex Hormones, Anti-Inflammatory Agents, Non-Steroidal, Biomarkers, Biopsy, Bursa, Synovial, Bursitis, Combined Modality Therapy, Cyclooxygenase 1, Cyclooxygenase 2, Cytokines, Fracture Fixation, Internal, Humans, Immunoenzyme Techniques, Interleukin-1, Interleukin-6, Joint Instability, Matrix Metalloproteinase 1, Matrix Metalloproteinase 9, Membrane Proteins, Metalloproteases, Observer Variation, Prostaglandin-Endoperoxide Synthases, Retrospective Studies, Rotator Cuff Injuries, Shoulder Fractures, Shoulder Impingement Syndrome, Single-Blind Method, Staining and Labeling, Tumor Necrosis Factor-alpha.
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Are proinflammatory cytokines and metalloproteases expressed in the subacromial bursa in patients with rotator cuff disease? Context: The pathophysiology of subacromial impingement syndrome is poorly understood. We investigated the expression of inflammatory cytokines, metalloproteases, and the cyclooxygenases in the subacromial bursa in control patients and in patients with rotator cuff tear. Basic science evaluation. Eighteen patients undergoing shoulder surgery had a subacromial bursa biopsy examination. Patients were divided into 2 groups. Group I (study group) had 10 patients with a full-thickness rotator cuff tear (RCT). Group II (control group) had 8 patients. Seven of 8 underwent shoulder arthroscopy with anterior capsular reconstruction for instability; 1 of 8 underwent open reduction internal fixation for acute proximal humerus fracture. None of the patients in group II had any history of symptoms or signs consistent with subacromial impingement. H&E and immunohistochemical antibody (MMP-1, MMP-9, IL-1, IL-6, TNF-alpha, COX-1, and COX-2) stained specimens were examined by 2 blinded observers using a histologic scale (grade 0 = no staining to grade 4 = intense staining). Histologic evidence of inflammation was present in all patients with RCT (group I). No or mild inflammation was noted in group II. The average staining grade for inflammatory cytokines (IL-1, IL-6, TNF-alpha) and proteinases (MMP-1 and MMP-9) was significantly more pronounced in the RCT group (P < .001). Cyclooxygenase enzymes (COX-1 and COX-2) were also increased in group II (P < .001).
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A high level of expression of inflammatory cytokines, proteinases, and cyclooxygenase enzymes, known to produce a catabolic environment, is present in the subacromial bursa of patients with rotator cuff tear. Final Decision: yes