Anesthesia Experts

Science, Medicine, and the Anesthesiologist

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Anesthesiology August 2024, Vol. 141, A13–A15.

Rotator cuff injuries affect more than 17 million individuals in the United States, leading to approximately 500,000 surgeries each year. These surgeries, which often involve the removal of the subacromial bursa, synovial-like tissue located between the rotator cuff and acromion, have high failure rates. This study demonstrates that the subacromial bursa plays an active role in the resolution of inflammatory and healing processes after tendon injury. Several experiments using clinical biopsies from nine patients with rotator cuff injury as well as a rodent model revealed that the bursa responds to tendon injuries by up-regulating genes linked to inflammation and healing (Cox2, IL6, Tgfb1). In rats, removing the bursa hindered resolution of inflammation and negatively affected the adjacent infraspinatus tendon and humeral head. Targeted treatment with dexamethasone in rats demonstrated potential therapeutic benefits by control of inflammation. However, limitations due to variability in patient samples suggest a need for more focused studies to develop tailored treatment strategies for rotator cuff injuries.

Take home message: After rotator cuff injury, the subacromial bursa plays a protective role, and targeting it with dexamethasone could help regulate inflammatory response in injured rotator cuff. Its routine removal during shoulder surgery should be reconsidered.

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