Abstract
The purpose of the study was to test the hypothesis that cellular mechanisms of fibroblasts derived from primary frozen shoulder(PFS) exhibit similar activity in terms of contraction, response to cytokine (transforming growth factor-beta1) and mechanical stimulation similar to that generated by fibroblasts derived from dupuytren’s disease. PFS is a debilitating disease of unknown aetiology, characterised by fibrosis with contracture of the cora-cohumeral ligament, tissues of the rotator interval and glenohumeral ligaments, leading to restrictive shoulder movements. Frozen shoulder has been postulated to be Dupuytren’s disease of the shoulder with an association inferred since 1936.
Materials and Methods: Primary explant cultures of fibroblasts from seven patients with PFS and five control patients were obtained using standard tissue culture techniques. Fibroblasts were seeded in 3-D collagen constructs and contraction force generated over 24hours measured using a culture force monitor(CFM) in real time. Increasing concentrations of TGF-beta1 were added to cell seeded gels and force generated measured using the CFM over 24hours. These mechanical output data were statistically compared to data available from Dupuytren’s disease.
Results and Discussion: Compared to Dupuytren’s fibroblasts, PFS fibroblasts showed a statistically reduced ability to contract a 3-D collagen gel over 24hours (p< 0.01). In Dupuytren’s disease, fibroblasts derived from nodules and cords generate peak forces of 140dynes and 110dynes respectively, while PFS fibro-blasts generated peak force of 8dynes The response to TGF-beta1 stimulation, which has been shown to enhance peak force contraction in Dupuytren’s fibro-blasts had no effect on PFS fibroblasts and this was statistically significant (p< 0.01).
Conclusion: These data suggest intrinsic differences in cellular activity and mechanisms between Dupuytren’s and Primary Frozen Shoulder even though clinically they both manifest with a contracted extracellular matrix affecting function and requiring surgical intervention. This may explain increasing post surgically recurrence in Dupuytren’s as compared to Primary Frozen Shoulder release.
Correspondence should be addressed to Mr Carlos Wigderowitz, Senior Lecturer, University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, Dundee DD1 9SY.
