Peripheral microcirculation alteration as cause of postero-superior rotator cuff tear: the possible indirect contribution of nailfold capillaroscopy.

Abstract

Most of the recent literature regarding rotator cuff tear etiology identifies in peripheral microcirculation disorders the probable main cause of tissue degeneration, and consequently of tendon rupture. Nailfold capillaroscopy is a practical and inexpensive diagnostic technique used to evaluate the health status of the peripheral microcirculation and, recently, its use has found other indications in addition to that of diagnosing connective tissue diseases and Raynaud's phenomenon. We verified the possible indirect contribution of nailfold capillaroscopy in the identification of peripheral microcirculation disturbances in a group of patients with rotator cuff tear and whether these possible alterations could be related to rotator cuff tear size. A case control study was performed. 100 patients [(56M-44F; mean age(SD): 60.46 (5.46)] with different sized postero-superior cuff tears and 100 healthy controls [(38M:62F mean age (SD):60.40(6.34)] were submitted to capillaroscopic exam. The following parameters were examined: capillary morphology and density; avascular areas; visibility of the sub-papillary venous plexus; enlarged and giant capillaries; ectasias and microaneurysms; neo-angiogenesis; hemosiderin deposits; pericapillary edema; capillary blood flow. Severe exclusion criteria were applied. Statistical analysis was performed. Visibility of SPVP (p<0.001), pericapillary edema (p<0.001), capillary blood flow (p<0.001), ectasias and microaneurysms (p<0.001) and neo-angiogenesis (p = 0.04) were significantly associated with presence of RCT. Our results contribute to support the hypothesis that microcirculation disorder has a relevant role on the genesis of cuff degeneration and, consequently, of tendon rupture. However, these alterations do not seem to be related to rotator cuff tear size.