Integrating Tendinous Pathophysiology Into Rotator Cuff Tears And Greater Trochanteric Pain Syndrome: A Narrative Review
DOI:
https://doi.org/10.5195/ijms.2024.2023Keywords:
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 cuffAbstract
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 done using Google Scholar 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
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 Rep. 2012;11(5):232–238.
Zhu MF, Musson DS, Cornish J, Young SW, Munro JT. Hip abductor tendon tears: where are we now? Hip Int. 2020;30(5):500–512.
Bunker TD, Esler CN, Leach WJ. Rotator-cuff tear of the hip. J Bone Joint Surg Br. 1997;79(4):618–620.
Varacallo M, El Bitar Y, Mair SD. Rotator Cuff Tendonitis. In: StatPearls [Internet]. Treasure Island (FL): 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. 2010;26(12):1697–1705.
Dwek JR, Pfirrmann CW, Stanley AJ, Pathria MN, Chung CB. MR imaging of the hip abductors: normal anatomy and commonly encountered pathology at the greater trochanter. Magn Reson Imaging Clin N Am. 2005;13(4):691–704.
Bird PA, Oakley SP, Shnier R, Kirkham BW. Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome. Arthritis Rheum. 2001;44(9):2138–2145.
Connell DA, Bass C, Sykes CA, 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: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
Neer CS II. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am. 1972;54(1):41–50.
McFarland EG, Maffulli N, Del Buono A, Murrell GA, Garzon-Muvdi J, Petersen SA. Impingement is not impingement: the case for calling it "rotator cuff disease." Muscles Ligaments Tendons J. 2013;3(3):196–200.
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. J Bone Joint Surg Am. 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. 2007;23(1):81–88.
Henkus HE, de Witte PB, Nelissen RG, Brand R, van Arkel ER. Bursectomy compared with acromioplasty in the management of subacromial impingement syndrome: a prospective randomized study. J Bone Joint Surg Br. 2009;91(4):504–510.
Shin SJ, Oh JH, Chung SW, Song MK. The efficacy of acromioplasty in the arthroscopic repair of small to medium-sized rotator cuff tears without acromial spur: prospective comparative study. Arthroscopy. 2012;28(5):628–635.
Pedowitz RA, Yamaguchi K, Ahmad CS, Burks RT, Flatow EL, et al. Optimizing the management of rotator cuff problems. J Am Acad Orthop Surg. 2011;19(6):368–379.
Almekinders LC, Weinhold PS, Maffulli N. Compression etiology in tendinopathy. Clin Sports Med. 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. J Bone Joint Surg Am. 2019;101(2):177–184.
Walsh MJ, Walton JR, Walsh NA. Surgical repair of the gluteal tendons. J 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). AJR Am J Roentgenol. 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. Orthop Traumatol Surg Res. 2014;100(8):849–853.
Robertson WJ, Gardner MJ, Barker JU, Boraiah S, Lorich DG, Kelly BT. Anatomy and dimensions of the gluteus medius tendon insertion. Arthroscopy. 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 JL, Purdam CR. Is compressive load a factor in the development of tendinopathy? Br J Sports Med. 2012;46(3):163–168.
Orchard J, Cook JL, Halpin N. Stress-shielding as a cause of insertional tendinopathy: the operative technique of limited adductor tenotomy supports this theory. J Sci Med 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, Schwenker C, Prescher A, Niethard FU. 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 PW, Bennell KL. Hip abductor muscle weakness in individuals with gluteal tendinopathy. Med Sci Sports Exerc. 2016;48(3):346–352.
Birnbaum K, Schwenker C, Hohmann D, Schrempf A, Prescher A, Bullmann V. Finite element model of the proximal femur under consideration of the hip centralizing forces of the iliotibial tract. Clin Biomech (Bristol, Avon). 2011;26(1):58–64.
Benjamin M, Ralphs JR. Fibrocartilage in tendons and ligaments—an adaptation to compressive load. J Anat. 1998;193(Pt 4):481–494.
Cook JL, Rio E, Purdam CR, Docking SI. 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. Br J Sports Med. 2009;43(4):280–283.
Scott A, Cook JL, Hart DA, Walker DC, Duronio V, Khan KM. 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 MH. The influence of mechanical forces on the glycosaminoglycan content of the rabbit flexor digitorum profundus tendon. Connect Tissue Res. 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. Br J Sports Med. 2009;43(6):409–416.
van Schie HT, de Vos RJ, de Jonge S, Bakker EM, Heijboer MP, Verhaar JA, Tol JL. Ultrasonographic tissue characterisation of human Achilles tendons: quantification of tendon structure through a novel non-invasive approach. Br J Sports Med. 2010;44(16):1153–1159.
Soslowsky LJ, Thomopoulos S, Esmail A, Flanagan CL, Iannotti JP, Williamson JD, Carpenter JE. Rotator cuff tendinosis in an animal model: role of extrinsic and overuse factors. Ann Biomed Eng. 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. Acad Radiol. 2016;23(10):1204–1213.
Taljanovic MS, Gimber LH, Becker GW, Latt LD, Klauser AS, Melville DM, Gao L, Witte RS. Shear-wave elastography: basic physics and musculoskeletal applications. Radiographics. 2017;37(3):855–870.
Feng YN, Li YP, Liu CL, Zhang ZJ. Assessing the elastic 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 Q. 2007;23(4):255–268.
Zhang ZJ, Ng GY, 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.
Published
How to Cite
License
Copyright (c) 2024 Joshua Poole, Erin Alaia, Robert J. Meislin
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from the Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Enforcement of copyright
The IJMS takes the protection of copyright very seriously.
If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.
If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to contact@ijms.org
Infringing material
If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to contact@ijms.org
