Overlapping, Masquerading, and Causative Cervical Spine and Shoulder Pathology: A Systematic Review.

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Abstract

Conflict of interest statement: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. 3. Nat Commun. 2024 Nov 1;15(1):9460. doi: 10.1038/s41467-024-53826-w. Classification of distinct tendinopathy subtypes for precision therapeutics. Tang C(#)(1)(2)(3)(4)(5)(6)(7), Wang Z(#)(1)(2)(3)(4)(6)(7)(8), Xie Y(#)(1)(2)(3)(4)(6)(7), Fei Y(1)(2)(3)(4)(6)(7), Luo J(1)(2)(3)(4)(6)(7), Wang C(1)(2)(3)(4)(7), Ying Y(9), He P(1)(2)(3)(4)(7), Yan R(6), Chen Y(1)(2)(3)(4)(6)(7), Huang J(1)(2)(3)(4)(6)(7), Xu Y(1)(2)(3)(4)(7), Wang Z(8), Heng BC(10), Liu H(1)(2)(3)(4)(7), Li J(8), Yin Z(2)(6)(7)(11), Wu H(1)(2)(3)(4), Chen W(1)(2)(3)(4), Ouyang H(12)(13)(14)(15), Chen X(16)(17)(18)(19), Shen W(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). Author information: (1)Department of Sports Medicine & Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China. (2)Institute of Sports Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, China. (3)Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, China. (4)Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou City, Zhejiang Province, China. (5)Binjiang Institute of Zhejiang University, Hangzhou City, Zhejiang Province, China. (6)Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, China. (7)Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China. (8)Department of Orthopedics, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou City, Zhejiang Province, China. (9)Key Laboratory of Reproductive Genetics (Ministry of Education) and Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China. (10)Department of Dental Materials & Dental Medical Devices Testing Center, Peking University School and Hospital of Stomatology, Beijing City, China. (11)China Orthopedic Regenerative Medicine Group (CORMed), Hangzhou City, Zhejiang Province, China. (12)Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, China. hwoy@zju.edu.cn. (13)Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China. hwoy@zju.edu.cn. (14)China Orthopedic Regenerative Medicine Group (CORMed), Hangzhou City, Zhejiang Province, China. hwoy@zju.edu.cn. (15)Liangzhu Laboratory, Zhejiang University, Hangzhou City, Zhejiang Province, China. hwoy@zju.edu.cn. (16)Institute of Sports Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, China. chenxiao-610@zju.edu.cn. (17)Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, China. chenxiao-610@zju.edu.cn. (18)Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China. chenxiao-610@zju.edu.cn. (19)China Orthopedic Regenerative Medicine Group (CORMed), Hangzhou City, Zhejiang Province, China. chenxiao-610@zju.edu.cn. (20)Department of Sports Medicine & Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China. wlshen@zju.edu.cn. (21)Institute of Sports Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, China. wlshen@zju.edu.cn. (22)Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, China. wlshen@zju.edu.cn. (23)Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou City, Zhejiang Province, China. wlshen@zju.edu.cn. (24)Binjiang Institute of Zhejiang University, Hangzhou City, Zhejiang Province, China. wlshen@zju.edu.cn. (25)Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, China. wlshen@zju.edu.cn. (26)Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China. wlshen@zju.edu.cn. (27)Department of Orthopedics, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou City, Zhejiang Province, China. wlshen@zju.edu.cn. (28)China Orthopedic Regenerative Medicine Group (CORMed), Hangzhou City, Zhejiang Province, China. wlshen@zju.edu.cn. (29)State Key Laboratory of Transvascular Implantation Devices, Hangzhou City, Zhejiang Province, China. wlshen@zju.edu.cn. (#)Contributed equally Erratum in Nat Commun. 2025 Jan 17;16(1):781. doi: 10.1038/s41467-025-55962-3. Rotator cuff tendinopathy is the most common tendinopathy type with the worst prognosis. Conventional treatments often elicit heterogeneous drug responses due to the diversity of tendinopathy. Hence, this study attempted a classification of 126 diseased tendons into three distinct subtypes with opposite pathogenic mechanisms based on transcriptomic and clinical features. The hypoxic atrophic subtype with white appearance (Hw) exhibits downregulated neovascularization pathways. The inflammatory proliferative subtype with white appearance (Iw) shows a moderate upregulation of inflammatory characteristics. The inflammatory proliferative subtype with red appearance (Ir) exhibits the highest levels of upregulated neovascularization and inflammatory pathways, along with severe joint dysfunction. We then established research models, including subtype-specific simulations in animal models and clinical data analysis. These revealed that glucocorticoid, a controversial commonly used drug, was only effective in treating the Ir subtype. Hence, the tendinopathy subtypes elucidated in this study have significant implications for developing precision treatment of tendinopathy. © 2024. The Author(s). DOI: 10.1038/s41467-024-53826-w PMCID: PMC11530571