title: Microvascular blood flow in normal and pathologic rotator cuffs.
abstract: BACKGROUND
  Microvascular blood flow in the tendon plays an important role in the pathogenesis of rotator cuff abnormalities. There are conflicting views about the presence of a hypovascular zone in the supraspinatus tendon. Besides, no studies have looked at the pattern of blood flow around a partial-thickness tear. Our aim was to measure microvascular blood flow in normal and a range of pathologic rotator cuff tendons using laser doppler flowmetry.
  
  
  METHODS
  A total of 120 patients having arthroscopic shoulder surgery were divided into 4 equal groups on the basis of their intraoperative diagnosis: normal rotator cuff, subacromial impingement syndrome, and partial-thickness or full-thickness rotator cuff tear. Microvascular blood flow was measured at 5 different regions of each cuff using a laser doppler probe. The values were compared to assess variability within and between individuals.
  
  
  RESULTS
  Total blood flow was greater in the normal rotator cuff group compared with the groups with pathologic rotator cuffs, with the largest difference seen in the subacromial impingement group. Within individuals, blood flow was highest at the musculotendinous junction and lowest at the lateral insertional part of the tendon. Among groups, the blood flow was significantly lower at the anteromedial and posteromedial cuff in the groups with impingement and full-thickness tears compared with the group with normal cuff.
  
  
  CONCLUSIONS
  Real-time in vivo laser doppler analysis has shown that microvascular blood flow is not uniform throughout the supraspinatus tendon. Blood flow in the pathologic supraspinatus tendon was significantly lower compared with the normal tendon.
authors.affiliation: Warwick Medical School, University of Warwick, Coventry, UK; Department of Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
authors.forename: Shanmugam
authors.initials: S
authors.lastname: Karthikeyan
authors.affiliation: Warwick Medical School, University of Warwick, Coventry, UK. Electronic address: damian.griffin@warwick.ac.uk.
authors.forename: Damian R
authors.initials: DR
authors.lastname: Griffin
authors.affiliation: Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Parsons
authors.affiliation: Department of Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Lawrence
authors.affiliation: Department of Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
authors.forename: Chetan S
authors.initials: CS
authors.lastname: Modi
authors.affiliation: Department of Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Drew
authors.affiliation: Department of Trauma and Orthopaedics, Royal Devon and Exeter NHS Trust, Exeter, UK.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001182:Arthroscopy; D005260:Female; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D008875:Middle Aged; D012039:Regional Blood Flow / Q000502:physiology*; D017006:Rotator Cuff / Q000098:blood supply* / Q000601:surgery; D000070636:Rotator Cuff Injuries; D019534:Shoulder Impingement Syndrome / Q000503:physiopathology*; D013708:Tendon Injuries / Q000503:physiopathology* / Q000601:surgery; D055815:Young Adult
keywords: Rotator cuff; blood flow; critical zone; cuff tear; impingement; laser doppler flowmetry; microvascular; supraspinatus