Chronicity is associated with the glenohumeral synovitis in patients with a rotator cuff tear

Abstract

Synovitis of the glenohumeral joint (GHJ) and subacromial space (SAS) is one of the most common findings during arthroscopic rotator cuff repair (RCR). The purpose of this study is to determine clinical factors associated with the degree of synovitis in patients with a rotator cuff tear and whether macroscopic synovitis affects early clinical outcomes following arthroscopic RCR. Arthroscopic videos of 230 patients treated with arthroscopic RCR were randomly reviewed by two experienced shoulder surgeons. The synovitis scores of the GHJ using Davis's grading system and the SAS using Jo's grading system were rated with a consensus. Univariate and multivariate analyses were used to identify the associations between the synovitis scores and various parameters, including demographics, preoperative, and postoperative clinical outcomes. Univariate analyses revealed that age, side, body mass index, duration of symptoms, preoperative stiffness, diabetes, muscle atrophy, fatty infiltration, tear size, preoperative clinical scores, and preoperative range of motion were significantly associated with the GHJ synovitis score (all p < 0.05). Multivariate analyses revealed that the duration of symptoms, tear size, and diabetes was significantly associated with the GHJ synovitis score (p = 0.048, p = 0.025, p = 0.011, respectively). Longer duration of symptoms, larger tear size, and the presence of diabetes was independently associated with increased GHJ synovitis in patients with a rotator cuff tear. These results suggest that GHJ synovitis might be more involved in the pathogenesis for pain and tear progression of rotator cuff disease compared with SAS synovitis.

Blood flow velocity in the anterior humeral circumflex artery and tear size can predict synovitis severity in patients with rotator cuff tears

“…Furthermore, our results showed that PSV in the AHCA correlated with synovitis in the SAS, which is a novel finding. Several previous studies evaluated synovitis in the GHJ and SAS separately [ 3 , 20 ] and showed that the effect on pain and function differed according to the degree of synovitis in these two sites. Therefore, it would be clinically relevant to evaluate and analyze GHJ and SAS synovitis severity separately.…”

“…Among the most common pathologies encountered during arthroscopic surgery in patients with RCTs is synovitis of the glenohumeral joint (GHJ) and subacromial space (SAS). In recent years, intraoperative grading systems for synovitis haves been established [ 1 , 2 ], and synovitis grade has been shown to have clinical relevance in contributing to pain and dysfunction in patients with RCTs [ 3 - 5 ].…”

Synchronization of Blood Flow Velocity in the Anterior Humeral Circumflex Artery and Reduction in Night Pain After Arthroscopic Rotator Cuff Repair: A Case Report

“…The lateral portion of the glenohumeral joint capsule receives its blood supply from the AHCA [ 11 ], and increased blood flow velocity in the AHCA has been reported to reflect synovitis in this area [ 7 ]. Recent studies have indicated that severe synovitis in the glenohumeral joint may be involved in the pathogenesis of pain [ 12 , 13 ]. Thus, our finding that blood flow velocity, which may reflect synovitis, was increased during the severe night pain phase in the patient after ARCR coincides with a recent study on RCT patients [ 7 ].…”

Evaluation of hypervascularity in synovitis of the shoulder using ultrasound: comparison of preoperative ultrasound findings and intraoperative arthroscopic findings

“…Previous studies have identified subacromial and glenohumeral synovitis as being a source of pain in rotator cuff disease. 1 , 3 , 12 , 16 , 20 Moreover, glenohumeral synovitis would be associated with early postoperative shoulder stiffness after ARCR. 29 Management of synovitis in the shoulder joint is one of the most important factors in the treatment of the shoulder joint.…”

“…Although the pathology of shoulder pain is still controversial, several studies have reported subacromial and glenohumeral synovitis as being a source of pain in rotator cuff disease. 1 , 3 , 12 , 16 , 20 Being female, age less than 50 years old, workers' compensation, diabetes, patients with partial tears, preoperative pain, and adhesive capsulitis have been reported as predictive factors for shoulder stiffness after ARCR. 13 , 14 , 25 , 30 Glenohumeral synovitis would be associated with early postoperative shoulder stiffness after ARCR.…”