Karthikeyan, Shanmugam (2016) Management of rotator cuff pathology. PhD thesis, University of Warwick.

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Abstract

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.

Item Type:	Thesis or Dissertation (PhD)
Subjects:	R Medicine > RD Surgery
Library of Congress Subject Headings (LCSH):	Shoulder joint -- Rotator cuff -- Wounds and injuries, Shoulder -- Ultrasonic imaging, Nonsteroidal anti-inflammatory agents -- Testing, Tendons -- Wounds and injuries
Official Date:	February 2016
Dates:	Date Event February 2016 Submitted
Institution:	University of Warwick
Theses Department:	Warwick Medical School
Thesis Type:	PhD
Publication Status:	Unpublished
Supervisor(s)/Advisor:	Griffin, Damian R. ; Smith, Christopher, D. ; Hutchinson, Charles
Format of File:	pdf
Extent:	256 leaves : illustrations, charts
Language:	eng

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