Archives of Orthopaedic and Trauma Surgery

, Volume 111, Issue 6, pp 336–340 | Cite as

Inflammation of the subacromial bursa in chronic shoulder pain

  • S. Santavirta
  • Y. T. Konttinen
  • I. Antti-Poika
  • D. Nordström
Clinical and Experimental Forum


Subacromial bursal tissue was studied in 12 patients operated on for painful (10 patients with constant pain and 2 patients with pain on motion) rotator cuff tendinitis/impingement syndrome. The Neer acromioplasty technique was used. Six patients had moderate inflammatory changes and one had a slight inflammation. In three of the five remaining patients, the subacromial bursa did not show any signs of inflammatory involvement, but patients experienced pain at rest and at night, reflecting clinical inflammation in tissues other than the bursa. The two patients with pain only on strain did not show inflammation of the bursa. Immunohistochemical typing of the bursal tissue disclosed a typical chronic mononuclear cell infiltrate consisting mainly of CD2-positive T lymphocytes (50–80% of all inflammatory cells), accompanied by less frequent CD11b (C3bi receptor) -positive monocyte/macrophages (10–40%). The relative paucity of plasmablasts/plasma cells expressing PCA-1 suggests this to be an inflammatory rather than an immune response. Active involvement of some of the local cells is suggested to be the source of algogenic and hyperalgesic substances contributing to pain in chronic shoulder pain syndromes.


Rotator Cuff Pain Syndrome Cell Infiltrate Active Involvement Local Cell 
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  1. 1.
    Burmester GR, Jahn B, Granatzki M (1984) Activated T cells in vivo and in vitro: divergents and expression of Tac and Ia antigens in the nonblastoid small T cells of inflammation and normal T cells activated in vitro. J Immunol 133:1230–1234Google Scholar
  2. 2.
    Doran JF, Jackson P, Kynoch PA, Thompson RJ (1983) Isolation of PGP 9.5, a new human neurone-specific proteins detected by high-resolution two-dimensional electrophoresis. J Neurochem 40:1542–1547Google Scholar
  3. 3.
    Fields HL (1990) Introduction. In: Fields HL (ed) Pain syndromes in neurology. Butterworths, London, pp 1–18Google Scholar
  4. 4.
    Grönblad M, Santavirta S, Antti-Poika I, Konttinen YT, Polak JM (1992) Protein gene product 9.5- (PGP 9.5), synaptophysin-and neuropeptide-immunoreactive nerves in human subacromial bursal tissue. (Submitted)Google Scholar
  5. 5.
    Jungell P, Konttinen YT, Nortamo P, Malmström M (1989) Immunoelectron microscopic study of distribution of T cell subsets in oral lichen planus. Scand J Dent Res 97:361–367Google Scholar
  6. 6.
    Harvey AR (1987) Neurophysiology of rheumatic pain. Baillieres Clin Rheumatol 1:1–26Google Scholar
  7. 7.
    Hsu SM, Raine L, Fanger H (1981) Use of avidin-biotin-peroxidase complex (ABC) in immunoperoxidase techniques: a comparison between ABC and unlabeled antibody (PAP) procedures. J Histochem Cytochem 29:577–580Google Scholar
  8. 8.
    Konttinen YT, Honkanen VEA (1988) Future trends in the treatment of rheumatoid arthritis in the light of current etiopathogenetic theories. Scand J Rheumatol [Suppl] 74:7–17Google Scholar
  9. 9.
    Konttinen YT, Reitamo S, Ranki A, Häyry P, Kankaanpää U, Wegelius O (1981) Characterization of the immunocompetent cells of rheumatoid synovium from tissue sections and eluates. Arthritis Rheum 24:71–79Google Scholar
  10. 10.
    Konttinen YT, Bergroth V, Nordström D, Koota K, Skrifvars B, Hagman G, Friman C, Hämäläinen M, Slätis P (1985) Cellular immunohistopathology of acute, subacute and chronic synovitis in rheumatoid arthritis. Ann Rheum Dis 44:549–555Google Scholar
  11. 11.
    Konttinen YT, Bergroth V, Nordström D, Segerberg-Konttinen M, Seppälä K, Salaspuro M (1987) Lymphocyte activation in vivo in the interstinal mucosa of patients with Crohn's disease. J Clin Lab Immunol 22:59–63Google Scholar
  12. 12.
    Konttinen YT, Segerberg-Konttinen YT, Nordström D, Bergroth V, Scheinin T, Saari H (1988) An immunoperoxidaseautoradiography double labeling method for analysis of lymphocyte activation markers and DNA synthesis. J Immunol Methods 110:19–27Google Scholar
  13. 13.
    Konttinen YT, Tuominen S, Segerberg-Konttinen M, Jugell P, Malmström M, Grönblad M, Güven O, Santavirta S, Panula P (1990) Mast cells in the labial salivary glands in patients with Sjögren's syndrome: a histological, immunohistological, and electron microscopical study. Ann Rheum Dis 49:685–689Google Scholar
  14. 14.
    Konttinen YT, von Essen R, Grönblad M, Vahvanen V, Santavirta S, Antti-Poika I, Hämäläinen M (1990) Fibroblasts in synovitis in rheumatoid arthritis but not in noninflammatory synovial tissue in meniscus lesions express the carboxyterminal domain of procollagen type I. Am J Clin Pathol 93: 340–346Google Scholar
  15. 15.
    Konttinen YT, Honkanen VEA, Grönblad M, Keinonen M, Santavirta N, Santavirta S (1992) Tender point score: a tool for the assessment of fibrositic pain; the relation to inflammatory joint disease and personality. J Rheumatol 19:851–855Google Scholar
  16. 16.
    McDonald JA, Broekelman TJ, Matheke ML, Crouch E, Koo M, Kuhn C III (1986) A monoclonal antibody to the carboxyterminal domain of procollagen type I visualizes collagen-synthesizing fibroblasts. Detection of an altered fibroblast phenotype in lungs of patients with pulmonary fibrosis. J Clin Invest 78:1237–1244Google Scholar
  17. 17.
    McMahon SB, Koltzenburg M (1990) Novel classes of nociceptors: beyond Sherrington. Trends Neurol Sci 13:199–201Google Scholar
  18. 18.
    Neer CS II (1972) Anterior acromioplasty for the chronic impingement syndrome of the shoulder. A preliminary report. J Bone Joint Surg [Am] 54:41–50Google Scholar
  19. 19.
    Neer CS II (1983) Impingement lesions. Clin Orthop 173:70–778Google Scholar
  20. 20.
    Santavirta S, Konttinen YT, Bergroth V, Eskola A, Tallroth K, Lindholm TS (1990) Aggressive granulomatous lesions associated with hip arthroplasty. Immunopathological studies. J Bone Joint Surg [Am] 72:252–258Google Scholar
  21. 21.
    Taiwo YO, Goetzel EL, Levine JD (1987) Hyperalgesia onset latency suggests a hierachy of action. Brain Res 423:333–337Google Scholar
  22. 22.
    Taiwo YO, Levine JD (1988) Characterization of the arachidonic acid metabolites mediating bradykinin and noradrenaline hyperalgesia. Brain Res 458:402–406Google Scholar
  23. 23.
    Thornhill TS (1985) Shoulder pain. In: Kelly E, Harris ED Jr, Ruddy S, Sledge CB (eds) Textbook of rheumatology, 2nd edn. Saudners, Philadelphia, pp 491–507Google Scholar
  24. 24.
    Wiedenmann B, Franke WW (1958) Identification of synaptophysin, an integral membrane glycoprotein of Mr 30000 characteristic of presynaptic vesicles. Cell 41:1017–1028Google Scholar
  25. 25.
    Wiedenmann B, Huffner WB (1989) Synaptolysin and chromogranins/secretogranins — widespread constitutents of distinct types of neuroendocrine vesicles and now tools in tumor diagnosis. Virchows Arch [B] 58:95–121Google Scholar
  26. 26.
    Wilkinson KD, Lee KM, Deshpande S, Dverksen-Hughes P, Boss JM, Pohl J (1989) Neuron-specific protein PGP 9.5 is a ubiquitin carboxyl-terminal hydrolase. Science 245:670–673Google Scholar

Copyright information

© Springer-Verlag 1992

Authors and Affiliations

  • S. Santavirta
    • 1
  • Y. T. Konttinen
    • 2
  • I. Antti-Poika
    • 3
  • D. Nordström
    • 4
  1. 1.Orthopaedic Hospital of the Invalid FoundationHelsinki 28Finland
  2. 2.Institute of Molecular Immunology, Hospital for Joint Diseases, Orthopedic InstituteNew YorkUSA
  3. 3.Peijas-Rekola HospitalVantaaFinland
  4. 4.Fourth Department of MedicineHelsinki University Central HospitalHelsinki 17Finland

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