title: The role of tendon and subacromial bursa in rotator cuff tear pain: a clinical and histopathological study.
abstract: OBJECTIVE
  To evaluate a possible association of shoulder pain with the clinical features and the histopathological changes occurring in the ruptured tendon and subacromial bursa of patients with rotator cuff tear.
  
  
  METHODS
  One hundred and eighty patients were clinically evaluated with the constant score and the visual analogue pain scale. Radiographs and MRI were performed. The chronology of the rupture, the muscle fatty degeneration according to Goutallier's scale and the tear size were evaluated. For each patient, a biopsy of the supraspinatus tendon and subacromial bursa was performed during arthroscopic rotator cuff tear repair and the specimens were histopathologically analysed.
  
  
  RESULTS
  Clinically, the shoulder was more painful in females, in the presence of a chronic cuff lesion and a low Goutallier's grade (P < 0.05). No association was found between pain and age of the patient and between pain and tear size. Histologically, hypertrophy and inflammation of the tendon and hypertrophy, inflammation, oedema and necrosis of the subacromial bursa were directly associated with pain (P < 0.05). Pain decreased significantly in the presence of fatty metaplasia and necrosis of the tendon (P < 0.05).
  
  
  CONCLUSIONS
  This study defines the main clinical and histopathological features of painful rotator cuff tear. In particular, a greater association of pain was observed with the histopathological changes in the bursa compared with those in the rotator cuff. Considering that the bursa plays also an essential role during the healing process, this "new" role of the subacromial bursa as pain generator has important repercussions in both pharmacological and surgical treatments of rotator cuff tears.
  
  
  METHODS
  IV.
authors.affiliation: Department of Orthopaedic Surgery, Istituto Chirurgico Ortopedico Traumatologico (ICOT), Latina, Italy. c_chillemi@libero.it.
authors.forename: Claudio
authors.initials: C
authors.lastname: Chillemi
authors.affiliation: Histology Unit, Department of Medico-Surgical Sciences and Biotechnologies, ICOT Latina, Sapienza University of Rome, Latina, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Petrozza
authors.affiliation: Department of Orthopaedics and Traumatology, ICOT, Sapienza University of Rome, Latina, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Franceschini
authors.affiliation: Department of Orthopaedic Surgery, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Garro
authors.affiliation: Department of Histopathology, Istituto Chirurgico Ortopedico Traumatologico (ICOT), Latina, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pacchiarotti
authors.affiliation: Histology Unit, Department of Medico-Surgical Sciences and Biotechnologies, ICOT Latina, Sapienza University of Rome, Latina, Italy.
authors.forename: Natale
authors.initials: N
authors.lastname: Porta
authors.affiliation: Histology Unit, Department of Medico-Surgical Sciences and Biotechnologies, ICOT Latina, Sapienza University of Rome, Latina, Italy.
authors.forename: Mirko
authors.initials: M
authors.lastname: Cirenza
authors.affiliation: Value Lab S.p.a, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Salate Santone
authors.affiliation: Istituto Clinico Humanitas IRCSS, Rozzano, MI, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Castagna
mesh_terms: D000368:Aged; D002061:Bursa, Synovial / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011859:Radiography; D017006:Rotator Cuff / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D000070636:Rotator Cuff Injuries / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D020069:Shoulder Pain / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D013708:Tendon Injuries / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D013710:Tendons / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology
keywords: Histopathology; Pain; Rotator cuff tear; Subacromial bursa; Tendon