CK values show great variability among individuals. Some athletes are low responders to physical training, with chronically low CK serum levels. Some athletes are high responders, with higher values of enzyme: the relationship among level of training, muscle size, fibre type and CK release after exercise should be investigated further. In addition, more details about hyperCKemia could come from the evaluation of the kinetics of CK after stress in healthy athletes with high levels of CK due to exercise, comparing the results with the ones obtained from athletes with persistent hyperCKemia at rest. Finally, it would be important to quantify the type of exercise more suited to athletes with myopathy and the intensity of exercise not dangerous for the progression of the pathology.

Muscle tissue may be damaged following intense prolonged training as a consequence of both metabolic and mechanical factors. Serum levels of skeletal muscle enzymes or proteins are markers of the functional status of muscle tissue, and vary widely in both pathological and physiological conditions. Creatine kinase, lactate dehydrogenase, aldolase, myoglobin, troponin, aspartate aminotransferase, and carbonic anhydrase CAIII are the most useful serum markers of muscle injury, but apoptosis in muscle tissues subsequent to strenuous exercise may be also triggered by increased oxidative stress. Therefore, total antioxidant status can be used to evaluate the level of stress in muscle by other markers, such as thiobarbituric acid-reactive substances, malondialdehyde, sulfhydril groups, reduced glutathione, oxidized glutathione, superoxide dismutase, catalase and others. As the various markers provide a composite picture of muscle status, we recommend using more than one to provide a better estimation of muscle stress.

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Despite the high level achieved in the field of shoulder surgery, a global consensus on rotator cuff tears management is lacking. This work is divided into two main sessions: in the first, we set questions about hot topics involved in the rotator cuff tears, from the etiopathogenesis to the surgical treatment. In the second, we answered these questions by mentioning Evidence Based Medicine. The aim of the present work is to provide easily accessible guidelines: they could be considered as recommendations for a good clinical practice developed through a process of sys- © C I C E d i z i o n i I n t e r n a z i o n a l i tematic review of the literature and expert opinion, in order to improve the quality of care and rationalize the use of resources. KEY WORDS: rotator cuff tears, Guidelines. IntroductionThe pathologies of the rotator cuff are common and they can be considered as a natural decline of the muscletendon unit in aging with statistically significant increase in frequency after 50 years. The painful shoulder is related in 30-70% of cases to disorders of the rotator cuff. The incidence of rotator cuff tears varies between 5 and 40%, although it is very difficult to establish the real incidence of these lesions, which are often asymptomatic. Currently, the pathology of the rotator cuff is considered to be multifactorial, because extrinsic and intrinsic factors play important roles, although it remains unclear the specific weight of each of these factors (Tab. 1). and often increased in number. staining eosinophilic There is a loss of orientation of homogeneous preparation the cores in relation to the bundles with hematoxylin/eosin. of collagen fibers. Chromatin has a dark color. Muscles, Ligaments and Tendons Grade 4 SevereComplete loss of orientation of The cores are reduced in number, Hyalinization with a homogeneous degeneration the collagen fiber bundles.small, dark and round. appearance. I.S.Mu.L.T -Rotator Cuff Tears Guidelines Grade 1The nuclei become more Colorable mucin between Decreased polarization Occasional clusters oval or round in shape fiber bundles but still fibers: separation of the of capillaries, less than without large cytoplasm. discrete number. individual fibers with one per 10 fields at high maintenance of the magnification. demarcation of the beams. Grade 2The nuclei are circular, Colorable mucin between Separation of the fibers 1-2 cluster of capillaries slightly widened and the fibers with loss with loss of demarcation for 10 fields at high a small amount of demarcation and a clear loss of normal magnification. of cytoplasm becomes of the beams. polarization. visible. Grade 3The nuclei are round, Abundant mucin among Demarcated separation More than two clusters wide with abundant poor colorable collagen. of fibers with complete to 10 fields at high cytoplasm and loss of architecture. magnification. the formation of a gap (chondroid change). © C I C E d i z i o n i I n t e r n a z i o n a l i MethodologyThe Authors were divided into four groups: -Coordinator: he conce...