Sunday, February 11, 2007


Rotator cuff patients should delay return to rigorous activity

SAN DIEGO - Patients who get a steroid injection in their shoulder for rotator cuff pain relief or improved shoulder function should not return to their regular activities or start physical therapy for a few weeks, a Loyola University Health System study shows.

“Steroid injection temporarily produces a molecular response in the tissue that is similar to that of a tendon injury, possibly making it more vulnerable to damage during this time,” said senior study investigator Dr. John Callaci, assistant professor, department of orthopedic surgery and rehabilitation, Loyola University Chicago Stritch School of Medicine, Maywood, Ill.

“This is especially important because steroids often give patients rapid pain relief,” said Callaci. “If a patient returns to rigorous activities right after a steroid injection, the weakened tissue may not be able to sustain itself.”

He cautioned that these findings should not preclude people from having a steroid injection or physicians from administering steroids. “The study gives us a better understanding of what is happening on the molecular level,” he said.

The Loyola researchers presented the findings here today at the 53rd annual meeting of the Orthopaedic Research Society.

“We found that steroid injections cause a tendon to behave in a way where it thinks it has been acutely injured,” noted Callaci. “Steroids rapidly provide anti-inflammatory and pain relief. That is why steroids are so popular, but physical therapy also can produce some of the same effects. It just takes longer.”

For the study, Callaci and colleagues examined the global gene expression profiles in rotator cuff tendons following injury or exposure to corticosteroid.

The researchers used gene array analysis of the complete rat genome to characterize the molecular response of rat rotator cuff tendon tissue to injury, injection of corticosteroids, and the presence of both injury and corticosteroid.

Results of the study shows that 2,000 genes were changed by injury; 1,000 genes were changed by steroids. A significant number, 750, of the changed genes overlapped between the two groups.

“Not only did gene expression overlap but so did some biological pathways,” said Callaci. “Acute injury of the rat rotator cuff tendon significantly modulated the expression of genes in 26 different biological pathways and steroids affected 13 pathways. Twelve of the 13 overlap with the injured pathways.

“The implication of an overlapping pathway is that you have pathways that are modulated after an injury suggesting the tendon is doing things to try to heal itself,” said Callaci. “That might suggest there might be a temporary period of vulnerability or weakness in a tendon. It thinks it is being injured and it produces things that normally it produces after injury, which might cause some temporary instability.”

Loyola currently is conducting a biomechanical study to determine if the steroids change strength, stress, strain or elasticity of tendons. “We are investigating the biological basis of how tendons heal and how steroids may modulate that healing,” said Callaci.

“We want to see if there are actual differences in biomechanical properties right after steroid injection,” he said. “If you have a tendon injury already and you’re given steroids, how is that modulating the healing response? Do you get more scar formation or do other things change? These are the questions we are researching now.”

Co-authors of the study with Callaci are principal investigator Dr. Anthony S. Wei, who did his research at Loyola and now is at Washington University Medical Center in St. Louis; Dr. Benjamin Sears, Loyola resident, Dr. Dainius Juknelis, research associate, Dr. Frederick Wezeman, professor of orthopaedic surgery and rehabilitation, Loyola University Chicago Stritch School of Medicine, director, musculoskeletal biology research laboratory, Loyola University Health System, and associate dean, Loyola University Chicago Graduate School at Loyola University Medical Center, Maywood, Ill.; and Dr. Pietro Tonino, associate professor of orthopaedic surgery, department of orthopaedic surgery and rehabilitation, Loyola University Chicago Stritch School of Medicine and chief of sports medicine.

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Funding for the study was provided by a gift from Mr. and Mrs. Charles R Walgreen III and a research grant from the Mid America Orthopaedic Association.

The 53rd Annual Meeting of the Orthopaedic Research Society at the San Diego Convention Center, 111 W. Harbor Drive, San Diego, runs through February 14, 2007.

About Loyola University Health System

Loyola University Health System (LUHS) is part of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and more than 30 primary and specialty care facilities in Cook, Will and DuPage counties. Loyola University Medical Center’s campus is conveniently located in Maywood, 13 miles west of Chicago’s Loop and 8 miles east of Oak Brook, Ill. At the heart of the medical center campus is a 559-licensed-bed hospital that houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children's Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as Loyola University Chicago Stritch School of Medicine, Loyola University Chicago Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb campus in Melrose Park includes the 255-licensed-bed community hospital, the Professional Office Building housing 150 private practice clinics, the Adult Day Care, the Gottlieb Center for Fitness, Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.

Trinity Health is a national Catholic health system with an enduring legacy and a steadfast mission to be a transforming and healing presence within the communities we serve. Trinity is committed to being a people-centered health care system that enables better health, better care and lower costs. Trinity Health has 88 hospitals and hundreds of continuing care facilities, home care agencies and outpatient centers in 21 states and 119,000 employees.