title: Immunobiological factors aggravating the fatty infiltration on tendons and muscles in rotator cuff lesions.
abstract: Rotator cuff lesions (RCLs) are a common cause of shoulder pain and dysfunction. The rotator cuff tendons can degenerate and/or tear from the greater tuberosity of the humerus, which is associated with several anatomical, physiological, biochemical, and molecular changes in tendon and muscle. In this article, these pathways are critically reviewed and discussed with various management strategies of RCLs. The article also highlights the immunobiological responses following the RCL and the inherent repair mechanisms elicited by the body. The greatest difficulty in treating this pathology is that the muscle can undergo irreversible fatty infiltration in the setting of chronic tears that is associated with poor surgical outcomes. The article also investigates the key molecular pathways of the muscle homeostasis (mTOR, Rho kinase, AMPK, and Ca(2+)) with the energy metabolism to propose a possible mechanism for fatty infiltration. Future research is warranted to target the key players of these pathways in the management of fatty infiltration and thus RCL.
authors.affiliation: Department of Clinical & Translational Science, Creighton University School of Medicine, Omaha, NE, USA.
authors.forename: Finosh G
authors.initials: FG
authors.lastname: Thankam
authors.affiliation: Department of Orthopedic Surgery, Creighton University School of Medicine, Omaha, NE, USA.
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Dilisio
authors.affiliation: Department of Clinical & Translational Science, Creighton University School of Medicine, Omaha, NE, USA. dkagr@creighton.edu.|Department of Clinical & Translational Science, The Peekie Nash Carpenter Endowed Chair in Medicine, Creighton University School of Medicine, CRISS II Room 510, 2500 California Plaza, Omaha, NE, 68178, USA. dkagr@creighton.edu.
authors.forename: Devendra K
authors.initials: DK
authors.lastname: Agrawal
mesh_terms: D000818:Animals; D002118:Calcium / Q000378:metabolism*; D005227:Fatty Acids / Q000378:metabolism*; D006801:Humans; D009124:Muscle Proteins / Q000378:metabolism*; D017006:Rotator Cuff / Q000378:metabolism* / Q000473:pathology; D013710:Tendons / Q000378:metabolism* / Q000473:pathology
chemical_list: D005227:Fatty Acids; D009124:Muscle Proteins; D002118:Calcium
keywords: Cell-based therapies; Enthesis; Fatty infiltration; Rotator cuff injury; Rotator cuff lesions; Tenocytes