Integrating Tendinous Pathophysiology Into Rotator Cuff Tears And Greater Trochanteric Pain Syndrome: A Narrative Review

Authors

DOI:

https://doi.org/10.5195/ijms.2024.2023

Keywords:

Shoulder, Hip Joint, Fibrocartilage, Shoulder joint, Tendons, Tendinopathy, Greater trochanteric pain syndrome (GTPS), Orthopedic complaints, Tendon pathology, Degenerative tears, Biomechanics, Metaplasia, Tensile forces, Pathophysiology, Trochanteric bursitis, Lateral hip pain, Gluteus minimus, Gluteus medius, Rotator cuff

Abstract

This narrative review aims to use the similarities between the shoulder and hip joints to better understand why rotator cuff (RC) tendinopathy and hip abductor tendinopathy occur and inform about diagnosis and treatment of both orthopedic complaints. A search of the literature was conducted using GoogleScholar and Pubmed and initially followed a systematic review protocol, but the nature of the topic, current literature and data necessitated a narrative review. Reports that discussed pathomechanics of RC and gluteal tendinopathy individually, together and with other muscles groups were reviewed. It was found that the methods measuring and describing the processes of tendinopathy differ significantly, for each individual joint and between all joints. A review of a large body of quantifiable measures and theoretical ideas regarding tendinopathy was performed to address this lack of consensus in current literature. Initial literature yielded 74 articles. After review, only 43 articles were used from a broad range of approaches and methodologies. The review found a body of evidence suggesting that fibrocartilage overgrowth and compressive forces over bony structures cause tendonous pathology of the RC and hip abductor tendons. These findings support the idea that tendinopathy is often caused by intrinsic factors rather than the traditional view of external factors. Earlier treatment and improved outcomes without surgery are possible using current imaging technology to identify these intrinsic factors that affect tendinous properties.

Metrics

Metrics Loading ...

References

Lequesne M. From “Periarthritis” To Hip “Rotator Cuff” Tears. Trochanteric Tendinobursitis. Joint Bone Spine 2006;73(4):344–348.

Ho GWK, Howard TM. Greater Trochanteric Pain Syndrome: More Than Bursitis And Iliotibial Tract Friction. Curr Sports Med reports 2012;11(5):217.

Zhu MF, Musson DS, Cornish J, Young S, Munro J. Hip abductor Tendon Tears: Where Are We Now? HIP International 2020;30(5):500–512.

Bunker TD, Esler CNA, Leach WJ. Rotator-Cuff Tear Of The Hip. J Bone Joint Surg Am.d.;3.

Varacallo M, El Bitar Y, Mair S. Rotator Cuff Tendonitis. In: Stat Pearls [Internet] StatPearls Publishing; 2023.

Domb BG, Nasser RM, Botser IB. Partial-Thickness Tears Of The Gluteus Medius: Rationale And Technique For Trans-Tendinous Endoscopic Repair. Arthroscopy: The Journal of Arthroscopic & Related Surgery 2010;26(12):1697–1705.

Dwek J, Pfirrmann C, Stanley A, Pathria M, Chung C. MR Imaging Of The Hip Abductors: Normal Anatomy And Commonly Encountered Pathology At The Greater Trochanter. Magnetic Resonance Imaging Clinics of North America 2005;13(4):691–704.

Bird PA, Oakley SP, Shnier R, Kirkham B. Prospective Evaluation Of Magnetic Resonance Imaging And Physical Examination Findings In Patients With Greater Trochanteric Pain Syndrome. Arthritis & Rheumatism 2001;44(9):2138–2145.

Connell DA, Bass C, Sykes CJ, Young D, Edwards E. Sonographic evaluation of gluteus medius and minimus tendinopathy. Eur Radiol 2003;13(6):1339–1347.

Grimaldi A, Fearon A. Gluteal Tendinopathy: Integrating Pathomechanics and Clinical Features In Its Management. J Orthop Sports Phys Ther 2015;45(11):910–922.

Syed MA, Azim SR, Baig M. Frequency Of Orthopedic Problems Among Patients Attending An Orthopedic Outpatient Department: A Retrospective Analysis Of 23 495 Cases. Ann Saudi Med 2019;39(3):172–177.

Seidman A, Taqi M, Varacallo M. Trochanteric Bursitis. In: Stat Pearls [Internet] StatPearls Publishing; 2023.

Neer CSI. Anterior Acromioplasty for The Chronic Impingement Syndrome In The Shoulder: A Preliminary Report. The Journal of Bone & Joint Surgery 1972;Volume 54(Issue 1):p 41-50.

McFarland EG, Maffulli N, Del Buono A, Murrel G, Garzon-Muvdi J, Petersen SA. Impingement Is Not Impingement: The Case For Calling It “Rotator Cuff Disease.” Muscle Ligaments and Tendons J 2019;03(03):196.

MacDonald P, McRae S, Leiter J, Mascarenhas R, Lapner P. Arthroscopic Rotator Cuff Repair With And Without Acromioplasty In The Treatment of Full-Thickness Rotator Cuff Tears: A Multicenter, Randomized Controlled Trial. The Journal of Bone and Joint Surgery-American Volume 2011;93(21):1953–1960.

Milano G, Grasso A, Salvatore M, Zarelli D, Deriu L Fabbriciani C.. Arthroscopic Rotator Cuff Repair With and Without Subacromial Decompression: A Prospective Randomized Study. Arthroscopy: The Journal of Arthroscopic & Related Surgery 2007;23(1):81–88.

Henkus HE, de Witte PB, Nelissen RGHH, Brand R, Van Arkel ERA. Bursectomy Compared With Acromioplasty In The Management Of Subacromial Impingement Syndrome: A Prospective Randomized Study. The Journal of Bone and Joint Surgery British volume 2009;91-B(4):504–510.

Shin S-J, Oh JH, Chung SW, Song Ml. The Efficacy of Acromioplasty In The Arthroscopic Repair Of Small To Medium-Sized Rotator Cuff Tears Without Acromial Spur: Prospective Comparative Study. Arthroscopy: The Journal of Arthroscopic & Related Surgery 2012;28(5):628–635.

Pedowitz RA, Yamaguchi K, Ahmad CS, Burks R, Flatow E. Optimizing The Management Of Rotator Cuff Problems: American Academy of Orthopaedic Surgeon 2011;19(6):368–379.

Almekinders LC, Weinhold PS, Maffulli N. Compression Etiology In Tendinopathy. Clinics in Sports Medicine 2003;22(4):703–710.

Tsutsumi M, Nimura A, Akita K. The Gluteus Medius Tendon and Its Insertion Sites: An Anatomical Study With Possible Implications For Gluteus Medius Tears. The Journal of Bone and Joint Surgery 2019;101(2):177–184.

Walsh MJ, Walton JR, Walsh NA. Surgical Repair Of The Gluteal Tendons. The Journal of Arthroplasty 2011;26(8):1514–1519.

Cvitanic O, Henzie G, Skezas N, Lyons J, Minter J. MRI Diagnosis Of Tears Of The Hip Abductor Tendons (Gluteus Medius And Gluteus Minimus). American Journal of Roentgenology 2004;182(1):137–143.

Makridis KG, Lequesne M, Bard H, Dijan P. Clinical and MRI results in 67 patients operated for gluteus medius and minimus tendon tears with a median follow-up of 4.6 years. Orthopaedics & Traumatology: Surgery & Research 2014;100(8):849–853.

Robertson WJ, Gardner MJ, Barker JU, et al. Anatomy And Dimensions Of The Gluteus Medius Tendon Insertion. Arthroscopy: The Journal of Arthroscopic & Related Surgery 2008;24(2):130–136.

Huegel J, Williams AA, Soslowsky LJ. Rotator Cuff Biology And Biomechanics: A Review Of Normal And Pathological Conditions. Curr Rheumatol Rep 2015;17(1):476.

Cook J, Purdam C. Is Compressive Load A Factor In The Development Of Tendinopathy? Br J Sports Med 2012;46(3):163–168.

Orchard J, Cook J, Halpin N. Stress-Shielding As A Cause Of Insertional Tendinopathy: The Operative Technique of Limited Adductor Tenotomy Supports This Theory. Journal of Science and Medicine in Sport 2004;7(4):424–428.

Woyski D, Olinger A, Wright B. Smaller Insertion Area and Inefficient Mechanics of the Gluteus Medius in Females. Surg Radiol Anat 2013;35(8):713–719.

Birnbaum K, Siebert CH, Pandorf T, Boraiah S, Lorich D, Kelly B. Anatomical and Biomechanical Investigations of the Iliotibial Tract. Surg Radiol Anat 2004;26(6):433–446.

Allison K, Vicenzino B, Wrigley TV, Grimaldi A, Hodges P, Bennel K. Hip Abductor Muscle Weakness In Individuals With Gluteal Tendinopathy. Medicine & Science in Sports & Exercise 2016;48(3):346–352.

Birnbaum K, Pandorf T. Finite Element Model of the Proximal Femur Under Consideration of the Hip Centralizing Forces of the Iliotibial Tract. Clinical Biomechanics 2011;26(1):58–64; doi: 10.1016/j.clinbiomech.2010.09.005.

Benjamin M, Ralphs JR. Fibrocartilage in Tendons and Ligaments - an Adaptation to Compressive Load. J Anatomy 1998;193(4):481–494.

Cook JL, Rio E, Purdam CR, Docking S. Revisiting the Continuum Model of Tendon Pathology: What is its Merit in Clinical Practice and Research? Br J Sports Med 2016;50(19):1187–1191.

Grigg NL, Wearing SC, Smeathers JE. Eccentric Calf Muscle Exercise Produces a Greater Acute Reduction in Achilles Tendon Thickness Than Concentric Exercise. British Journal of Sports Medicine 2009;43(4):280–283.

Scott A, Cook JL, Hart DA Walkder D, Duronio V Khan K. Tenocyte Responses To Mechanical Loading In Vivo: A Role For Local Insulin-Like Growth Factor 1 Signaling In Early Tendinosis In Rats. Arthritis Rheum 2007;56(3):871–881.

Gillard GC, Reilly HC, Bell-booth PG, Flint M. The Influence Of Mechanical Forces On The Glycosaminoglycan Content Of The Rabbit Flexor Digitorum Profundus Tendon. Connective Tissue Research 1979;7(1):37–46.

Cook JL, Purdam CR. Is Tendon Pathology A Continuum? A Pathology Model To Explain The Clinical Presentation Of Load-Induced Tendinopathy. British Journal of Sports Medicine 2009;43(6):409–416.

Van Schie HTM, de Vos RJ, de Jonge S, Bakker EM, Heijboer MP. Ultrasonographic Tissue Characterisation of Human Achilles Tendons: Quantification of Tendon Structure Through a Novel Non-invasive Approach. British Journal of Sports Medicine 2010;44(16):1153–1159.

Soslowsky LJ, Thomopoulos S, Esmail A, Flanagan C, Iannotti J, Williamson J, et al. Rotator Cuff Tendinosis In An Animal Model: Role Of Extrinsic And Overuse Factors. Annals of Biomedical Engineering 2002;30(8):1057–1063.

Dirrichs T, Quack V, Gatz M, Tingart M, Kuhl C, Schrading S. Shear Wave Elastography (SWE) For The Evaluation Of Patients With Tendinopathies. Academic Radiology 2016;23(10):1204–1213.

Taljanovic MS, Gimber LH, Becker GW, Latt D, Klauser A Melville D, Goa Liang, et al. Shear-Wave Elastography: Basic Physics And Musculoskeletal Applications. RadioGraphics 2017;37(3):855–870.

Feng YN, Li YP, Liu CL, Zhang ZJ. Assessing The Eastic Properties of Skeletal Muscle and Tendon Using Shearwave Ultrasound Elastography and MyotonPRO. Sci Rep 2018;8(1):17064.

Garra BS. Imaging And Estimation Of Tissue Elasticity By Ultrasound. Ultrasound Quarterly 2007;23(4):255–268.

Zhang ZJ, Ng GYF, Fu SN. Effects of Habitual Loading on Patellar Tendon Mechanical and Morphological Properties in Basketball and Volleyball Players. Eur J Appl Physiol 2015;115(11):2263–2269.

Downloads

Published

2024-07-03

How to Cite

Poole, J. R., Alaia, E., & Meislin, R. J. (2024). Integrating Tendinous Pathophysiology Into Rotator Cuff Tears And Greater Trochanteric Pain Syndrome: A Narrative Review. International Journal of Medical Students, 228–235. https://doi.org/10.5195/ijms.2024.2023