Expression of growth factors, cytokines and matrix metalloproteinases in frozen shoulder

Abstract

Received 4 February 1999; Accepted after revision 2 July 1999The term 'frozen shoulder' was first used by Codman 1 who described the common features such as pain of gradual onset, which is felt near the insertion of the deltoid, inability to sleep on the affected side, painful restriction of elevation and external rotation and a normal radiological appearance. The disorder is characterised by dense fibrosis of the capsule of the shoulder, 2-4 in which the cellular element consists of fibroblasts and myofibroblasts, 5,6 leading to a contracture of the rotator interval and the coracohumeral ligament, which restricts movement. 7-9Cytokines and other cellular growth factors are known to regulate the growth and function of fibroblasts in connective tissue. They are cell messengers derived from lymphoid cells, platelets, epithelial cells, endothelial cells, mesangial cells and fibroblasts and act in minute concentrations (nanomolar and femtomolar) by binding to cell receptors, causing a hormone-like action. One of their basic functions is the control of healing in damaged tissues. This process involves the accumulation of fibroblasts at the site of healing and is brought about by chemotaxis (attracting fibroblasts from elsewhere) and proliferation of fibroblasts. Cytokines and growth factors can also modulate the synthesis of collagen by fibroblasts.The histological feature of frozen shoulder is a matrix of type-I and type-III collagen populated by fibroblasts and myofibroblasts which suggests that the condition may be modulated by an abnormality in the production of cytokines and growth factors. Previous studies have shown a striking resemblence between the histology, immunocytochemistry,

Frozen Shoulder: Evidence and a Proposed Model Guiding Rehabilitation

“…100 Although the precise etiology remains unclear, recent evidence identifies elevated serum cytokine levels as part of the process. 19,49,101 Cytokines and other growth factors facilitate tissue repair and remodeling as part of the inflammatory process. Elevated cytokine levels appear predominately involved in the cellular mechanisms of sustained inflammation and fibrosis in primary and some secondary frozen shoulder.…”

“…Elevated cytokine levels appear predominately involved in the cellular mechanisms of sustained inflammation and fibrosis in primary and some secondary frozen shoulder. 19,49,75,101 Although the initial stimulus is unknown, Bunker et al 19 Frozen shoulder is typically considered an inflammatory process; however, this concept is being challenged. No significant inflammatory cells in the capsular tissue have been identified upon histological examination.…”

“…No significant inflammatory cells in the capsular tissue have been identified upon histological examination. 18,19,64,115 Numerous investigators report the visual presence of synovitis consistent with inflammation, 43,79,83,123 yet focal vascularity and synovial angiogenesis (increased papillary growth), rather than synovitis, are described by others. 18,50,124 In addition to confirmation of angiogenesis, frequent positive staining for nerve cells was found in patients with frozen shoulder.…”

A Complete Expression Profile of Matrix-Degrading Metalloproteinases in Dupuytren’s Disease

“…19 A reverse-transcription polymerase chain reaction (PCR)-based comparison of Dupuytren's tissue with frozen shoulder or control shoulder tissues showed expression of MMP1, MMP2, MMP9, and TIMP1 in all tissues, with MMP3 absent from DD tissue and MMP14 increased compared with shoulder tissue. 20 An earlier report also showed an increased expression of MMP-2 and MMP-9 in Dupuytren's tissue in response to mechanical load. 21 None of these studies were able to look at all members of the MMP, TIMP, and related metalloproteinase gene families.…”

IGF2 expression and β-catenin levels are increased in Frozen Shoulder Syndrome

“…is disorder a ects an estimated 2% of adults, is frequently bilateral and can be resistant to therapeutic interventions. Despite its common occurrence, the underlying pathophysiology of this disorder remains ill-de ned [1,2]. Previous studies have suggested that FSS shares a similar patho-mechanism with Dupuytren's disease (DD) [1], and that these two connective tissue disorders are clinically associated [3][4][5][6][7][8][9][10][11][12][13].…”