The rotator cuff refers to a group of four muscles, which arise from the scapula and insert into the head of humerus forming a cuff around the shoulder joint. They contribute to shoulder movements and provide dynamic stability at the shoulder joint. Pathology of the rotator cuff is the commonest cause for shoulder pain and its severity can vary from subacromial impingement to full thickness tears. NSAIDs and corticosteroids are two of the commonest group of drugs used in treating subacromial impingement syndrome but with conflicting evidence about their relative efficacy and risk of complications. I explored the efficacy of a subacromial NSAID (Tenoxicam) injection in a double blind randomised controlled trial but found it to be less effective compared to a subacromial corticosteroid injection as measured by functional shoulder scores at six weeks. During the trial, I recognised that there were unresolved challenges in using Ultrasonography to diagnose rotator cuff pathology especially in differentiating between partial and full thickness tears. In this thesis, I have presented the normal ultrasound dimensions of the rotator cuff in asymptomatic young adults under the age of forty years, which has not been documented before. The study showed that the measurements are significantly different between men and women but not between dominant and non-dominant arms, suggesting that in every individual the contralateral shoulder can be used as a control, especially where the diagnosis is uncertain. Exploration of factors associated with the pathogenesis of rotator cuff tendinopathy showed that a critical zone of hypoperfusion in the supraspinatus tendon could be a factor but the evidence for it has been contradictory. An observational study presented in this thesis describes the microvascular blood flow in normal and a spectrum of pathological rotator cuffs (subacromial impingement, partial thickness tears and full thickness tears) using Laser Doppler Flowmetry in patients undergoing arthroscopic shoulder surgery. The study showed variations in microvascular blood flow in normal rotator cuffs but no evidence of a “critical zone”. Blood flow was found to be significantly lower in all groups of pathological rotator cuffs.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:720428 |
| Date | January 2016 |
| Creators | Karthikeyan, Shanmugam |
| Publisher | University of Warwick |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://wrap.warwick.ac.uk/89698/ |
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