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Revista Médica Sinergia

2023, Number 07

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Revista Médica Sinergia 2023; 8 (07)

Rotator cuff tendinopathy: update on the pathophysiology and the diagnostic-therapeutic approach

Hernández GR, Coto QA, Rodríguez SD

Language: Spanish
References: 17
Page:
PDF size: 261.62 Kb.


ABSTRACT

Shoulder pain is the third cause of consultation in primary care related to joint pain and rotator cuff tendinopathy is the most common of them, it affects the quality of life of those how suffer from it. The pathology comprises an umbrella of terms that makes research difficult to make; in addition, the physiopathology is complex and not entirely known. The most widely accepted theory of pathogenesis is the mechanical theory. The diagnosis is mainly clinical without the need of radiological confirmation. To this day, management of the pathology is still conservative, with therapeutic modalities focused on reduction of pain and improvement in function of the joint. Furthermore, none of the therapeutic approaches have proved to regenerate the tendons. Progressive load exercises to the tendon have shown to be the most effective treatment modality in the conservative approach to the pathology, although the best protocol has not been stablished yet; moreover, many of the patients don´t respond adequately to this modality, therefore, it is important to consider adjunct therapies as a complement to exercises without substituting them. One of the most recent adjunct therapies is platelet rich plasma, it has been theoretically suggested that it has the capacity to regenerate the injured tendon since platelets are rich in growth factors. Nonetheless, its role has only been evaluated in terms of reduction of pain and improvement in function of the joint. Rehabilitation programs should be multimodal and individualized in order to be successful.


REFERENCES

  1. Millar NL, Silbernagel KG, Thorborg K, Kirwan PD, Galatz LM, Abrams GD, et al. Tendinopathy. Nature Reviews Disease Primers [Internet]. 2021 [citado el 20 marzo 2023];7(1):1–17. DOI: 10.1038/s41572-020-00234-1. PMID: 33414454. Disponible en: https://pubmed.ncbi.nlm.nih.gov/33414454/

  2. Leong H, Fu S, He X, Oh J, Yamamoto N, Yung S. Risk factors for rotator cuff tendinopathy: A systematic review and meta-analysis. Journal of Rehabilitation Medicine [Internet]. 2019 [citado el 20 marzo 2023];51(9):627–37. DOI: 10.2340/16501977-2598. PMID: 31489438. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31489438/

  3. Dadgostar H, Fahimipour F, Pahlevan Sabagh A, Arasteh P, Razi M. Corticosteroids or platelet-rich plasma injections for rotator cuff tendinopathy: A randomized clinical trial study. Journal of Orthopaedic Surgery and Research [Internet]. 2021 [citado el 20 marzo 2023];16(1):1–8. DOI: 10.1186/s13018-021-02470-x. PMID: 34020672. Disponible en: https://pubmed.ncbi.nlm.nih.gov/34020672/

  4. Llopis E, Perez A, Cerezal L. Rotator Cuff. En: Hodler J, Kubik-Huch R, Schulthess G (eds). Musculoskeletal Diseases 2021-2024, Diagnostic Imaging. Gewerbestrass: Springer; 2021. p. 11–8.

  5. Weiss LJ, Wang D, Hendel M, Buzzerio P, Rodeo SA. Management of rotator cuff injuries in the elite athlete. Current Reviews in Musculoskeletal Medicine [Internet]. 2018 [citado el 20 marzo 2023];11(1):102–12. DOI: 10.1007/s12178-018-9464-5. PMID: 29332181. Disponible en: https://pubmed.ncbi.nlm.nih.gov/29332181/

  6. Jain NB, Gao C, Richardson BE. Rotator Cuff Tendinopathy. In: Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2020. p. 84–9.

  7. Cardoso TB, Pizzari T, Kinsella R, Hope D, Cook JL. Current trends in tendinopathy management. Best Practice & Research Clinical Rheumatology [Internet]. 2019 [citado el 20 marzo 2023];33(1):122–40. DOI: 10.1016/j.berh.2019.02.001. PMID: 31431267. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31431267/

  8. Doiron-Cadrin P, Lafrance S, Saulnier M, Cournoyer É, Roy J-S, Dyer J-O, et al. Shoulder rotator cuff disorders: A systematic review of clinical practice guidelines and semantic analyses of recommendations. Archives of Physical Medicine and Rehabilitation [Internet]. 2020 [citado el 20 marzo 2023];101(7):1233–42. DOI: 10.1016/j.apmr.2019.12.017. PMID: 32007452. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32007452/

  9. Naunton J, Street G, Littlewood C, Haines T, Malliaras P. Effectiveness of progressive and resisted and non-progressive or non-resisted exercise in rotator cuff related shoulder pain: A systematic review and meta-analysis of randomized controlled trials. Clinical Rehabilitation [Internet]. 2020 [citado el 20 marzo 2023];34(9):1198–216. DOI: 10.1177/0269215520934147. PMID: 32571081. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32571081/

  10. Lin M-T, Chiang C-F, Wu C-H, Huang Y-T, Tu Y-K, Wang T-G. Comparative effectiveness of injection therapies in rotator cuff tendinopathy: A systematic review, Pairwise and network meta-analysis of randomized controlled trials. Archives of Physical Medicine and Rehabilitation [Internet]. 2019 [citado el 20 marzo 2023];100(2):1–12. DOI: 10.1016/j.apmr.2018.06.028. PMID: 30076801. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30076801/

  11. Dominguez-Romero JG, Jiménez-Rejano JJ, Ridao-Fernández C, Chamorro-Moriana G. Exercise-based muscle development programs and their effectiveness in the functional recovery of rotator cuff tendinopathy: A systematic review. Diagnostics [Internet]. 2021 [citado el 20 marzo 2023];11(3):1–22. DOI:10.3390/diagnostics11030529. PMID: 33809604. Disponible en: https://pubmed.ncbi.nlm.nih.gov/33809604/

  12. Thepsoparn M, Thanphraisan P, Tanpowpong T, Itthipanichpong T. Comparison of a platelet-rich plasma injection and a conventional steroid injection for pain relief and functional improvement of partial supraspinatus tears. Orthopaedic Journal of Sports Medicine [Internet]. 2021 [citado el 20 marzo 2023];9(9):1–7. DOI: 10.1177/23259671211024937. PMID: 34485587. Disponible en: https://pubmed.ncbi.nlm.nih.gov/34485587/

  13. Bhan K, Singh B. Efficacy of platelet-rich plasma injection in the management of rotator cuff tendinopathy: A review of the current literature. Cureus [Internet]. 2022 [citado el 20 marzo 2023];14(6):1–9. DOI: 10.7759/cureus.26103. PMID: 35875287. Disponible en: https://pubmed.ncbi.nlm.nih.gov/35875287/

  14. Rodriguez-Santiago B, Castillo B, Baerga-Varela L, Micheo WF. Rehabilitation management of rotator cuff injuries in the master athlete. Current Sports Medicine Reports [Internet]. 2019 [citado el 20 marzo 2023];18(9):330–7. DOI: 10.1249/JSR.0000000000000628. PMID: 31503045. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31503045/

  15. Hopewell S, Keene DJ, Heine P, Marian IR, Dritsaki M, Cureton L, et al. Progressive exercise compared with best-practice advice, with or without corticosteroid injection, for rotator cuff disorders: The grasp factorial RCT. Health Technology Assessment [Internet]. 2021 [citado el 20 marzo 2023];25(48):1–158. DOI: 10.3310/hta25480. PMID: 34382931. Disponible en: https://pubmed.ncbi.nlm.nih.gov/34382931/

  16. Longo UG, Risi Ambrogioni L, Berton A, Candela V, Carnevale A, Schena E, et al. Physical therapy and precision rehabilitation in shoulder rotator cuff disease. International Orthopaedics [Internet]. 2020 [citado el 20 marzo 2023];44(5):893–903. DOI: 10.1007/s00264-020-04511-2. PMID:32157371. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32157371/

  17. Rossi LA, Piuzzi N, Giunta D, Tanoira I, Brandariz R, Pasqualini I, et al. Subacromial platelet-rich plasma injections decrease pain and improve functional outcomes in patients with refractory rotator cuff tendinopathy. Arthroscopy: The Journal of Arthroscopic & Related Surgery [Internet]. 2021 [citado el 20 marzo 2023];37(9):2745–53. DOI: 10.1016/j.arthro.2021.03.079. PMID: 33892072. Disponible en: https://pubmed.ncbi.nlm.nih.gov/33892072/




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