Posted on 04/29/2024 9:07:52 PM PDT by ConservativeMind
A common practice of shoulder surgeons may be impairing the success of rotator cuff surgery, a study from orthopedic scientists and biomedical engineers suggests.
During the surgery, surgeons often remove a tissue called the bursa while repairing torn tendons in the shoulder joint, but the study suggests that the small tissue plays a role in helping the shoulder heal.
The bursa is a thin, fluid-filled sac originally thought to protect the tendons by providing a cushion between the tendons and adjacent bones.
The bursa often becomes inflamed, sometimes concurrently, when underlying tendons are injured, and surgeons often remove the tissue because they suspect it is a source of shoulder inflammation and pain. But recent studies suggest the tissue may be playing other biological roles besides mechanical cushioning, including promoting healing of injuries to the tendons in the shoulder.
To explore the bursa in rotator cuff disease, Thomopoulos and Brittany Marshall examined rats with repaired rotator cuff injuries, with and without bursa removal.
The researchers found that the presence of the bursa protected the undamaged tendon by maintaining its mechanical properties and protected the bone by maintaining its morphometry. When the bursa was removed, strength of the undamaged tendon deteriorated and the bone quality deteriorated.
"The loss of mechanical integrity in the uninjured tendon in the absence of the bursa was striking," Thomopoulos says.
In the damaged tendon, the researchers found the bursa promoted an inflammatory response and activated wound healing genes.
"Overall, what we're seeing is a beneficial role of the bursa for rotator cuff health, in contrast with the historical view that the inflamed bursa is detrimental," says Thomopoulos.
The researchers documented similar changes to cells and proteins in bursa samples from patients who underwent surgery to repair rotator cuff injuries, suggesting comparable processes may occur in people.
(Excerpt) Read more at medicalxpress.com ...
I had an outbreak of Bursitis last week for the first time in my life. (67 y/o). Lots of edema in the right leg. A sore and swollen knee. Two long, sleepless nights. Luckily, the entire event only lasted about three days, just when I was planning transportation to an Urgent Care clinic. My main Doc. told me what the condition was called. Just when you think you’ve experienced it all.
They repaired it all and left the bursa. Might be why my recovery went so well. Except for the PT. PT hurts. A lot.
I learned the hard way how complicated the shoulder joint is. I ended up getting 9 surgeries after the doctor who performed the first one destroyed my shoulder. It took another 8 surgeries to get my shoulder to where I can use my arm again. I went in to have a small tear repaired and left with a much larger tear, the removal of part of my collarbone and AC joint and titanium anchors that didn’t stay in place.
You win!
I have only had about 4-5.
Pity only the abstract is available...
https://www.science.org/doi/10.1126/scitranslmed.add8273
But why do I think this is really about something other than Big Med having a Duh! moment...?
From the abstract...
“...To evaluate the potential of the bursa as a therapeutic target, polymer microspheres loaded with dexamethasone were delivered to the intact bursae of rats after tenotomy. Dexamethasone released from the bursa reduced Il1b expression in injured rat supraspinatus tendon, suggesting that the bursa could be used for drug delivery to reduce inflammation in the healing tendon...”
Not mentioned in abstract, but I’ll betcha stem cells, gene therapy are also being studied.
Lots of painful PT but I was back playing 8 months later.
It involved arthroscopic surgery rather than cutting.
Bump for future reference.
Ooopsie!
Glad I turned down surgery and let things heal naturally.
I had complete tears of rotator cuff and biceps, skipped the surgery and had acupuncture instead. No pain and range of motion much improved.
Vit B12 shots daily can usually cure bursitis in @ 2 weeks
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