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Peter Biberthaler, MD et al ABSTRACT More than 70 years ago, Codman
described a region of avascularity or reduced vascularity in the
supraspinatus tendon that led to failure.
Over the years, various other studies have been done to indicate
that there is reduced blood flow in the critical area where tears occur. Investigations into microcirculation use intravital
fluorescence microscopy, which requires the application of potentially
toxic substances into the tissue. A
new instrument, called orthogonal polarizational spectral imaging, uses
polarized reflected light instead of fluorescent light to image the
microvascular structure. The
purpose of this study was to provide the first glimpse of the
microvascular structure of the supraspinatus, both at the region of the
lesion, and at the area near the attachment to bone, where no problems
were noted. A total of 11 patients, mean age 56
years, were used in this study. 4
had complete tears and 7 had incomplete tears, and all were undergoing
surgery for correction and acromioplasty.
All had the microvascular tissues studied using the OPS at the
region of the lesion and at the bony attachment, and also had tissue
samples from both regions taken for immunohistochemical analysis. Results show that at the region of
the bony attachment, the capillary density was 106 +/- 13, while at the
site of the lesion; the quantity was only 20 +/-14.
The diameter of the vessels did not vary at either site.
Histochemical and microscopic examination revealed significantly
more vessels in the control bony area as opposed to the lesion area. COMMENTS Another study that seems to
definitively indicate that at the region where patients have their
supraspinatus lesion, there is a marked reduction in the number of
microvessels. Now that we are
sure, we need to examine how our PT treatment can either positively or
negatively affect this region. Does
TFM create such a tissue disturbance that damage occurs due to an
insufficient blood supply, or does it stimulate the development of vessels
due to the trauma? Does the
amount of dexamethasone introduced via iontophoresis stay in the target
tissues better, as there is less blood supply to flush it out?
How about the previous study done on this site that showed no
steroid in the venous return of the arm after the treatment anyway?
How about US? Can the
reduced capillary beds handle the heat that occurs from constant US?
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