Translational targeting of inflammation and fibrosis in frozen shoulder: Molecular dissection of the T cell/IL-17A axis.

Frozen shoulder is a common fibroproliferative disease characterized by the insidious onset of pain and restricted range of shoulder movement with a significant socioeconomic impact. The pathophysiological mechanisms responsible for chronic inflammation and matrix remodeling in this prevalent fibrotic disorder remain unclear; however, increasing evidence implicates dysregulated immunobiology. IL-17A is a key cytokine associated with inflammation and tissue remodeling in numerous musculoskeletal diseases, and thus, we sought to determine the role of IL-17A in the immunopathogenesis of frozen shoulder.

Novel self-amplificatory loop between T cells and tenocytes as a driver of chronicity in tendon disease.

Objectives: Increasing evidence suggests that inflammatory mechanisms play a key role in chronic tendon disease. After observing T cell signatures in human tendinopathy, we explored the interaction between T cells and tendon stromal cells or tenocytes to define their functional contribution to tissue remodelling and inflammation amplification and hence disease perpetuation.

Methods: T cells were quantified and characterised in healthy and tendinopathic tissues by flow cytometry (FACS), imaging mass cytometry (IMC) and single cell RNA-seq.

Fibroblast activation and inflammation in frozen shoulder.

Introduction: Frozen shoulder is a common, fibro-proliferative disease characterised by the insidious onset of pain and progressively restricted range of shoulder movement. Despite the prevalence of this disease, there is limited understanding of the molecular mechanisms underpinning the pathogenesis of this debilitating disease. Previous studies have identified increased myofibroblast differentiation and proliferation, immune cell influx and dysregulated cytokine production.

The epidemiology of acromioclavicular joint excision.

Background: With the development of arthroscopic procedures such as subacromial decompression (ASAD) and rotator cuff repair (RCR), it is hypothesized that there may have been a similar rise in the performance of acromioclavicular joint excision (ACJE). The purpose of this study was to investigate the epidemiology of ACJE to examine incidence, surgical technique, age, gender of patients and associated procedures in an urban population.

Methods: A prospectively collected surgical database was retrospectively examined to identify patients undergoing ACJE.

Alarmins in Frozen Shoulder: A Molecular Association Between Inflammation and Pain.

Background: The pathophysiological mechanisms behind proliferation of fibroblasts and deposition of dense collagen matrix in idiopathic frozen shoulder remain unclear. Alarmins (also known as danger signals) are endogenous molecules that are released into the extracellular milieu after infection or tissue injury and that signal cell and tissue damage.

Purpose: To investigate whether the presence of alarmins is higher in patients with idiopathic frozen shoulder than in control subjects.

IL-17A mediates inflammatory and tissue remodelling events in early human tendinopathy.

Increasingly, inflammatory mediators are considered crucial to the onset and perpetuation of tendinopathy. We sought evidence of interleukin 17A (IL-17A) expression in early human tendinopathy and thereafter, explored mechanisms whereby IL-17A mediated inflammation and tissue remodeling in human tenocytes. Torn supraspinatus tendon (established pathology) and matched intact subscapularis tendon (representing 'early pathology') along with control biopsies were collected from patients undergoing shoulder surgery.

IL-21 receptor expression in human tendinopathy.

The pathogenetic mechanisms underlying tendinopathy remain unclear, with much debate as to whether inflammation or degradation has the prominent role. Increasing evidence points toward an early inflammatory infiltrate and associated inflammatory cytokine production in human and animal models of tendon disease. The IL-21/IL-21R axis is a proinflammatory cytokine complex that has been associated with chronic inflammatory diseases including rheumatoid arthritis and inflammatory bowel disease.

Biomechanical analysis of locked and non-locked plate fixation of the clavicle.

Introduction: During plate fixation of clavicular fractures the brachial plexus and subclavian vessels are vulnerable to injury beneath the clavicle. Locking plate fixation allows for mono-cortical fixation, theoretically reducing the risk of injury to these structures. Biomechanical analysis of the performance of such fixation is limited, and this study was designed to explore this further as a treatment option in clavicle fractures.

Inflammation is present in early human tendinopathy.

Background: The cellular mechanisms of tendinopathy remain unclear particularly with respect to the role of inflammation in early disease. The authors previously identified increased levels of inflammatory cytokines in an early human model of tendinopathy and sought to extend these studies to the cellular analysis of tissue.

Purpose: To characterize inflammatory cell subtypes in early human tendinopathy, the authors explored the phenotype and quantification of inflammatory cells in torn and control tendon samples.

Local anaesthetic infusion with elastomeric pump after arthroscopic subacromial decompression.

Introduction: The use of extended local anaesthesia for postoperative pain has previously been reported, and has several advantages over other methods, including ease of placement, safety, reliability, lower cost and effective analgesia. We present our experience with a portable elastomeric infusion device in patients undergoing arthroscopic subacromial decompression, and make a case for its potential to allow same-day discharge.

Patients And Methods: Forty patients undergoing arthroscopic subacromial decompression were followed-up.

Brachial artery transection associated with closed and open dislocation of the elbow.

Acute dislocations of the elbow complicated by brachial artery involvement are rare but serious injuries. Rapid assessment and a high index of suspicion are essential to facilitate prompt treatment, as delay in diagnosis is associated with a poorer outcome. We present two cases of brachial artery transection after closed and open dislocation of the elbow, and discuss the appropriate management of such patients.

Semi-open needle biopsy of the upper thoracic spine.

Study Design: A semi-open needle technique allowing safe biopsy of the upper thoracic spine is described.

Summary Of Background Data: It has been performed in five cases with an accuracy of 100% and no complications.

Conclusion: The authors recommend its use between T1 and T4, or where the normal anatomy is very distorted.

Squamous carcinoma of the rectum.

A case of squamous carcinoma of the rectum in a 50-year-old woman is reported, which was treated by excisional surgery and then radiotherapy. The patient is alive and well, with no evidence of tumour recurrence 6 years later. The aetiology and treatment of this uncommon tumour is discussed.

Gastric leiomyosarcoma: two unusual cases.

Two cases of gastric leiomyosarcoma, which presented unusually with lower abdominal masses, are described. The difficulties in the preoperative diagnosis of this rare malignancy are discussed.