We treated 22 patients with a diagnosis of primary frozen shoulder resistant to conservative treatment by manipulation under anaesthetic and arthroscopic release of the rotator interval, at a mean time from onset of 15 months (3 to 36). Biopsies were taken from this site and histological and immunocytochemical analysis was performed to identify the types of cell present. The tissue was characterised by the presence of fibroblasts, proliferating fibroblasts and chronic inflammatory cells. The infiltrate of chronic inflammatory cells was predominantly made up of mast cells, with T cells, B cells and macrophages also present. The pathology of frozen shoulder includes a chronic inflammatory response with fibroblastic proliferation which may be immunomodulated.

No abstract

The antigenic phenotype of human fetal osteoclasts was compared with that of human tissue macrophages and macrophage polykaryons in foreign body lesions using a large number of monoclonal antibodies directed against myeloid (granulocyte/mononuclear phagocyte) antigens. Osteoclasts expressed a restricted range of macrophage-associated antigens including CD13, CD15A, CD44, CD45, CDS4, (ICAM-1), CD71 (transferrin receptor), and CD68. These antigens were also present on macrophages and macrophage polykaryons both of which also strongly expressed CD1 la,b,c, CD18, (LFA family), CD14, CD31, CD36, CD37, CD39 and CD43 antigens. There was also weak and occasional expression of CD16 (FcRIII), CD25 (interleukin 2 receptor), CD32 (FcRII), CD35 (C3b receptor) and HLA-DR by macrophage polykaryons.The presence of some macrophage associated antigens on osteoclasts is consistent with their originating from cells of the mononuclear phagocyte system. The numerous differences in antigenic phenotype between osteoclasts and macrophage polykaryons, however, suggest that their pathways of development and differentiation are not identical. The differences discerned in antigenic phenotype should also permit distinction between these polykaryons (and possibly their mononuclear precursors) in normal and diseased tissues. Cryostat sections and bone imprints were stained by an indirect immunoperoxidase technique as previously described.'8 Antibodies were in the form of ascites diluted in hybridoma culture medium to recommended concentrations, or where this was not known, to concentrations of 1 in 100 and 1 in 250. Negative controls consisted of the addition of culture medium alone without primary antibody. Absence of reactivity with osteoblasts and cartilage cells in cryostat bone sections also served as an internal negative control. Positive controls consisted of antibody to common HLA-A,B,C determinants (WK/32HL).The monoclonal antibodies used in this study were all taken from the Non-Lineage and Myeloid Panels of the Fourth International Workshop on Human Leucocyte Differentiation Antigens, 1989, and are shown in table 1. The antibodies were grouped into clusters each of which recognise a defined antigen of a similar distinct molecular weight. The antibodies were also evaluated for similarities and differences in the pattern of reactivity against marrow, circulating, and tissue fixed granulocytes and mononuclear phagocytes.'9 Results HISTOLOGICAL ASSESSMENTBoth imprints and cryostat sections of metaphyseal bone contained large numbers ofosteoclasts. Confirmation that the multinucleated cells in bone imprints are osteoclasts has been shown by their specific morphological response to calcitonin.20 Other morphologically identifiable scattered cells in the imprints include erythrocytes, megakaryocytes, platelets, monocytes and granulocytes.Joint capsule from revision hip arthroplasties contained abundani material, largely high density I acrylic material; the former al tile fragments of foreign mater as rounded empty spaces mononuclea...

No abstract