Murphy Geoffrey T, Beretov Julia, Marvi Salman, Lam Patrick H, Murrell George A C
Orthopaedic Research Institute, Kogarah, Australia.
St George Hospital, Kogarah, Australia.
Am J Sports Med. 2023 Feb;51(2):343-350. doi: 10.1177/03635465221142611. Epub 2023 Jan 13.
Pain is a common presentation after glenohumeral labral injuries. However, the source of that pain is undetermined.
PURPOSE/HYPOTHESIS: We aimed to determine if there is a differential expression of nerve fibers around the glenoid labrum and if torn labra have increased neuronal expression compared with untorn labra (rotator cuff repair labra). We hypothesized that the superior labrum would have a higher concentration of neurofilament than would the rest of the labrum and that the concentration of neurofilament would increase at the site of a labral tear.
Descriptive laboratory study.
Seven labra were sampled at the 3-, 5-, 9-, and 12-o'clock positions during total shoulder arthroplasty. Samples were also collected at the 3-, 5-, and 12-o'clock positions during rotator cuff repair (16 labra), anterior labral repair (6 labra), type II superior labral anterior to posterior (SLAP) repair (4 labra), and capsular release for idiopathic capsulitis (5 labra). Sections were immunostained with antibodies to neurofilament, a specific neuronal marker that is used to identify central and peripheral nerve fibers, and the concentration and intensity of immunostained-positive cells assessed.
The concentration of neurofilament staining was similar in the superior, anterior, posterior, and inferior glenoid labrum in untorn labra (8 neurofilament expressing cells per square millimeter; = .3). Torn labra exhibited a 3- to 4-fold increase in neuronal expression, which was isolated to the location of the tear in SLAP ( = .09) and anterior labral tears ( = .02). The concentration of neurofilament expressing cells in torn glenoid labrum samples was comparable that in with the glenoid labrum of adhesive capsulitis samples ( = .7).
This study supports the hypothesis that after a tear of the anterior or superior labrum the labrum in that region becomes populated with new nerves fibers and that these fibers may be responsible for the pain noted by patients with superior (SLAP) and/or anterior labral (Bankart) tears.
This study suggests that neural infiltration contributes to the pain experienced by patients with labral tears. It may help with patient education and direct future management of labral lesions.
疼痛是盂肱关节盂唇损伤后的常见表现。然而，疼痛的来源尚不确定。
目的/假设：我们旨在确定盂唇周围神经纤维是否存在差异表达，以及与未撕裂的盂唇（肩袖修复盂唇）相比，撕裂的盂唇是否具有增加的神经元表达。我们假设上盂唇的神经丝浓度会高于盂唇的其他部分，并且神经丝浓度会在盂唇撕裂部位增加。
描述性实验室研究。
在全肩关节置换术中，于3点、5点、9点和12点位置采集7个盂唇样本。在肩袖修复（16个盂唇）、前盂唇修复（6个盂唇）、II型上盂唇前后向（SLAP）修复（4个盂唇）以及特发性关节囊炎的关节囊松解术（5个盂唇）过程中，也在3点、5点和12点位置采集样本。切片用针对神经丝的抗体进行免疫染色，神经丝是一种用于识别中枢和外周神经纤维的特异性神经元标记物，并评估免疫染色阳性细胞的浓度和强度。
在未撕裂的盂唇中，上、前、后和下盂唇的神经丝染色浓度相似（每平方毫米8个神经丝表达细胞； = 0.3）。撕裂的盂唇神经元表达增加了3至4倍，这在SLAP撕裂（ = 0.09）和前盂唇撕裂（ = 0.02）中仅限于撕裂部位。撕裂的盂唇样本中神经丝表达细胞的浓度与粘连性关节囊炎样本的盂唇浓度相当（ = 0.7）。
本研究支持以下假设，即在前盂唇或上盂唇撕裂后，该区域的盂唇会有新的神经纤维生长，并且这些纤维可能是导致上盂唇（SLAP）和/或前盂唇（Bankart）撕裂患者疼痛的原因。
本研究表明神经浸润是盂唇撕裂患者疼痛的原因之一。它可能有助于患者教育，并指导未来盂唇损伤的管理。
