Rotator cuff tear may have significance include os acromiale and acromial spurs. Environmental factors implicated include increasing age, shoulder overuse, smoking, and any medical condition that affects circulation or impairs the inflammatory and healing response, such as diabetes mellitus. Intrinsic factors refer to injury mechanisms that occur within the rotator cuff itself. The principal is a degenerative-microtrauma model, which supposes that age-related tendon damage compounded by chronic microtrauma results in partial tendon tears that then develop into full rotator cuff tears. As a result of repetitive microtrauma in the setting of a degenerative rotator cuff tendon, inflammatory mediators alter the local environment, and
Mucous sheaths of the tendons around the ankle the level of the tip of the malleolus, while that for the Flexor digitorum longus is slightly higher; the former is continued to the base of the first metatarsal, but the latter stops opposite the first cuneiform bone. On the lateral (outer) side of the ankle a sheath which is single for the greater part of its extent encloses the Peronæi longus and brevis. It extends upward for about 4 cm. above the tip of the malleolus and downward and forward for about the same distance. Mucous sheaths of the tendons around the ankle The mucous sheaths of the tendons