Shoulder surface temperature and bone scintigraphy findings in patients with rotator cuff tears

Yoichi Koike, Hirotaka Sano, Takeshi Kinjyo, Itaru Imamura, Onuma Masahiro, Masako Goto, Masamizu Ooyama, Atushi Kita, Eiji Itoi, Yoichi Koike, Hirotaka Sano, Takeshi Kinjyo, Itaru Imamura, Onuma Masahiro, Masako Goto, Masamizu Ooyama, Atushi Kita, Eiji Itoi

Abstract

Background: Complex regional pain syndrome (CRPS) is one of the serious complications after surgical treatment of a rotator cuff tear. Both a measurement of body surface temperature and bone scintigraphy have been used as diagnostic tools for the early phase of CRPS.Unfortunately, few studies have been carried out that applied these methods to the patients after rotator cuff repair.

Purposes: To clarify both shoulder surface temperature and bone scintigraphy findings in patients with rotator cuff tears.

Subjects and methods: Subjects comprised patients with unilateral rotator cuff tears (five men and five women, mean age 61 years). For measurements of shoulder surface temperature, a Thermochron was attached to both shoulders. As for bone scintigraphy, intravenous injection of technetium-labelled hydroxymethylenebisphosphonic acid (99mTc-HMDP)was performed, and then images were taken with a gamma camera.

Results: During the measurements, the changes in body surface temperature for the affected and healthy shoulders remained within the standard deviation of the reference group. The intensity of radioisotope (RI) uptake for the affected shoulder joint was significantly increased compared to that for the healthy shoulder joint (P < 0.05).

Conclusion: RI uptake is increased in shoulders with rotator cuff tears, whereas shoulder surface temperature shows no differences on the affected and unaffected sides.

Figures

Figure 1.
Figure 1.
Time-dependent changes in the mean shoulder surface temperature.The changes in body surface temperature for the affected (bold line) and healthy shoulders (thin line) remained within the standard deviation (SD) of the reference group (dotted line with SD bars).
Figure 2.
Figure 2.
The intensity of radioisotope(RI) uptake. The intensity of RI uptake for the affected shoulder joint is significantly increased compared to that for the healthy shoulder joint. In elbow and wrist joints, there are no significant differences in RI uptake intensity between the affected and healthy sides. In the reference group, no significant left–right differences are seen for the shoulder, elbow, and wrist joints. (*Affected side 3.0 ± 1.0 versus healthy side 2.3 ± 0.7; P < 0.05).
Figure 3.
Figure 3.
Case 1: A 71-year-old male with a rotator cuff tear in the left shoulder. No obvious changes of osteoarthritis are observed on plain X-rays (A). A full-thickness rotator cuff tear is observed on the coronal T2 WI MRI (B, arrow). An increase of RI uptake in the left shoulder joint is observed in the bone scintigram (C, arrow). However, there are no left–right differences in RI uptake for elbow or wrist joints.
Figure 4.
Figure 4.
Case 2: A 51-year-old male with a rotator cuff tear in the right shoulder. No obvious osteoarthritis is observed in X-rays (A). A full-thickness rotator cuff tear was observed on the coronal T2 WI MRI (B, arrow). An increase of RI uptake in the left shoulder joint is observed in the bone scintigram (C, arrow). In SPECT images, RI uptakes are evident in the greater tuberosity of the humerus, the coracoid process of the scapula, and the glenohumeral joint (D, arrows).

References

    1. Steinbrocker O. The shoulder-hand syndrome: present perspective. Arch Phys Med Rehabil. 1968;49:388–95.
    1. Koike Y,Sano H, Imamura I, Goto M, Ooyama M, Kita A. Changes with time in skin temperature of the shoulders in healthy controls and a patient with shoulder-hand syndrome. Ups J Med Sci. 2010;115:260–5.
    1. Atkins RM. Complex regional pain syndrome.J Bone Joint. Surg Br. 2003;85:1100–6.
    1. Bickerstaff DR, Charlesworth D, Kanis JA. Changes in cortical and trabecular bone in algodystrophy. Br J Rheumatol. 1993;32:46–51.
    1. Harden RN, Bruehl SP. Diagnosis of complex regional pain syndrome: signs, symptoms, and new empirically derived diagnostic criteria. Clin J Pain. 2006;22:415–19.
    1. Zyluk A. The usefulness of quantitative evaluation of three-phase scintigraphy in the diagnosis of post-traumatic reflex sympathetic dystrophy. J Hand Surg Br. 1999;24:16–21.
    1. Miyakoshi N, Itoi E, Sato K, Suzuki K, Matsuura H. Skin temperature of the shoulder: circadian rhythms in normal and pathologic shoulders. J Shoulder Elbow Surg. 1988;7:625–8.
    1. Schuind FA, Mouraux D, Robert C, Brassinne E, Rémy P, Salvia P, et al. Functional and outcome evaluation of the hand and wrist. Hand Clin. 2003;19:361–9.
    1. Hirooka A, Yoneda M, Wakaitani S, Isaka Y, Hayashida K, Fukushima S, et al. Augmentation with a Gore-Tex patch for repair of large rotator cuff tears that cannot be sutured. J Orthop Sci. 2002;7:451–6.
    1. The Journal of the Shoulder Joint Editorial Committee: Manual for Evaluation of the Shoulder (JOA Score) The shoulder joint (katakansetsu) 2005;29:747–8. (Japanese)
    1. Sumitani M, Shibata M, Sakaue G, Mashimo T, Japanese Complex Regional Pain Syndrome Research Group Development of comprehensive diagnostic criteria for complex regional pain syndrome in the Japanese population. Pain. 2010;150:243–9.
    1. Masaki M, Koshimoto C, Tsuchiya K, Nishiwaki A, Morita T. Body temperature profile of the Korean field mouse Apodemus peninsulae during winter aggregation. Mammal Study. 2005;30:33–40.
    1. Jobe FW, Bradley JP. The diagnosis and nonoperative treatment of shoulder injuries in athletes. Clin Sports Med. 1989;8:419–38.
    1. Caliş M, Akgün K, Birtane M, Karacan I, Caliş H, Tüzün F. Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Ann Rheum Dis. 2000;59:44–7.
    1. Kräuchi K, Wirz-Justice A. Circadian rhythm of heat production, heart rate, and skin and core temperature under unmasking conditions in men. Am J. Physiol. 1994;267:R819–29.
    1. Scales WE, Vander AJ, Brown MB, Kluger MJ. Human circadian rhythms in temperature, trace metals, and blood variables. J Appl Physiol. 1988;65:1840–6.
    1. Bogh M, Minors DS, Waterhouse JM. Can insulated skin temperature act as a substitute for rectal temperature when studying circadian rhythms? Chronobiol Int. 1994;11:332–9.
    1. Rietveld WJ, Minors DS, Waterhouse JM. Circadian rhythms and masking: an overview. Chronobiol Int. 1993;10:306–12.
    1. Jeracitano D, Cooper RG, Lyon LJ, Jayson MI. Abnormal temperature control suggesting sympathetic dysfunction in the shoulder skin of patients with frozen shoulder. Br J Rheumatol. 1992;3:539–42.
    1. Vecchio PC, Adebajo AO, Chard MD, Thomas PP, Hazleman BL. Thermography of frozen shoulder and rotator cuff tendinitis. Clin Rheumatol. 1992;1:382–4.
    1. Waldburger M, Meier JL, Gobelet C. The frozen shoulder: diagnosis and treatment. Prospective study of 50 cases of adhesive capsulitis. Clin Rheumatol. 1992;11:364–8.
    1. Müller LP, Müller LA, Happ J, Kerschbaumer F. Frozen shoulder: a sympathetic dystrophy? Arch Orthop Trauma Surg. 2000;120:84–7.
    1. Wiffen F. What role does the sympathetic nervous system play in the development of ongoing pain of adhesive capsulitis? Journal of Manual & Manipulative Therapy. 2002;10:17–23.

Source: PubMed

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