TY - THES A1 - Klein, Thomas T1 - Establishing an in vitro disease model for Fabry Disease using patient specific induced pluripotent stem cell-derived sensory neurons T1 - Etablierung eines in vitro Krankheitsmodells für M. Fabry mittels patienteneigener sensibler Neurone, generiert über induzierte pluripotente Stammzellen N2 - Fabry disease (FD) is an X-linked lysosomal storage disorder caused by deficiency of the α-galactosidase A (GLA), leading to intracellular accumulations of globotriaosylceramide (Gb3). Acral burning pain, which can be triggered by heat, fever or physical activity is an early hallmark of FD and greatly reduces patients’ quality of life. The pathophysiology of FD pain is unknown and research is hindered by the limited in vivo availability of suitable human biomaterial. To overcome this obstacle, we generated induced pluripotent stem cells (iPSC) from one female and two male patients with a differing pain phenotype, and developed a refined differentiation protocol for sensory neurons to increase reliability and survival of these neurons, serving as an in vitro disease model. Neurons were characterized for the correct neuronal subtype using immunocytochemistry, gene expression analysis, and for their functionality using electrophysiological measurements. iPSC and sensory neurons from the male patients showed Gb3 accumulations mimicking the disease phenotype, whereas no Gb3 depositions were detected in sensory neurons derived from the female cell line, likely caused by a skewed X-chromosomal inactivation in favor of healthy GLA. Using super-resolution imaging techniques we showed that Gb3 is localized in neuronal lysosomes of male patients and in a first experiment using dSTORM microscopy we were able to visualize the neuronal membrane in great detail. To test our disease model, we treated the neurons with enzyme replacement therapy (ERT) and analyzed its effect on the cellular Gb3 load, which was reduced in the male FD-lines, compared to non-treated cells. We also identified time-dependent differences of Gb3 accumulations, of which some seemed to be resistant to ERT. We also used confocal Ca2+ imaging to investigate spontaneous neuronal network activity, but analysis of the dataset proofed to be difficult, nonetheless showing a high potential for further investigations. We revealed that neurons from a patient with pain pain are more easily excitable, compared to cells from a patient without pain and a healthy control. We provide evidence for the potential of patient-specific iPSC to generate a neuronal in vitro disease model, showing the typical molecular FD phenotype, responding to treatment, and pointing towards underlying electrophysiological mechanisms causing different pain phenotypes. Our sensory neurons are suitable for state-of-the-art microscopy techniques, opening new possibilities for an in-depth analysis of cellular changes, caused by pathological Gb3 accumulations. Taken together, our system can easily be used to investigate the effect of the different mutations of GLA on a functional and a molecular level in affected neurons. N2 - Morbus Fabry (M. Fabry) ist eine X-chromosomal vererbte lysosomale Speichererkrankung, die durch die Defizienz von α-Galaktosidase A (GLA) verursacht wird. Diese führt zu pathologischen Ablagerungen von Globotriaosylceramid (Gb3) in Zellen. Akraler, brennender Schmerz, der durch Hitze, Fieber oder Sport ausgelöst werden kann, ist ein frühes Krankheitsmerkmal und reduziert die Lebensqualität der Patienten deutlich. Die Pathophysiologie von M. Fabry ist unklar und die Forschung ist durch die limitierte Verfügbarkeit von humanem Biomaterial nur eingeschränkt möglich. Um dieses Problem zu bewältigen haben wir induzierte pluripotente Stammzellen (iPSC) von einer weiblichen Patientin und zwei männlichen Patienten mit unterschiedlichen Schmerzphänotypen generiert. Mit diesen Zellen konnten wir ein verbessertes Protokoll zur Herstellung sensibler Neurone etablieren um diese als in vitro Krankheitsmodell zu nutzen. Die Neurone wurden mittels Immunozytochemie, Genexpressionsanalyse und elektrophysiologischer Messungen auf die korrekte Zellidentität und deren Funktionalität getestet. Gb3 Ablagerungen konnten als Krankheitsmerkmal in iPSC und sensiblen Neuronen der männlichen Patienten, nicht aber in Zellen der weiblichen Patientin und der Kontrollperson nachgewiesen werden. Das Fehlen von pathologischen Ablagerungen in Zellen der weiblichen Betroffenen ist vermutlich auf eine verschobene X-Inaktivierung zu Gunsten des gesunden GLA zurückzuführen. Nichtsdestotrotz ist es uns durch die Nutzung hochauflösender Mikroskopietechniken gelungen, bei männlichen Patienten Gb3 in neuronalen Lysosomen nachzuweisen und die Membran in großem Detail abzubilden. Die Behandlung der Neurone mit der Enzymersatztherapie (ERT) als Nachweis für die Funktionalität des Krankheitsmodells führte zu einer Reduktion der Gb3 Ablagerungen bei männlichen Zellen, im Vergleich zu unbehandelten Zellen. Zudem konnten wir unterschiedliche Arten von Gb3 Akkumulationen identifizieren, von denen einige scheinbar behandlungsresistent sind. Erste Versuche mit Ca2+ Imaging zeigten spontane, neuronale Netzwerkaktivität, die noch weitergehend analysiert werden müssen. Mittels Patch-Clamp Analysen konnten wir zeigen, dass Neurone des Patienten mit Schmerzen leichter erregbar sind als Zellen des Patienten ohne Schmerzen, was einen Hinweis auf die mögliche Beteiligung gestörter Ionenkanäle gibt. Wir konnten zeigen, dass patientenspezifische iPSC geeignet sind um ein neuronales in vitro Krankheitsmodell zu erstellen. Dieses Modell zeigt den typischen molekularen Phänotypen des M. Fabry, spricht auf ERT an und liefert erste Hinweise auf pathologische elektrophysiologische Krankheitsursachen, die zu unterschiedlichen Schmerzphänotypen führen können. Zelluläre Veränderungen durch Gb3 Ablagerungen können nun mittels neuester Mikroskopietechniken anhand der von uns generierten Neurone untersucht werden um ein besseres Verständnis der zugrundeliegenden Pathophysiologie zu bekommen. Zusammenfassend bietet unser System eine neue Möglichkeit den neuronalen Einfluss verschiedener GLA Mutationen auf einer funktionellen und molekularen Ebene zu untersuchen und die Diversität von M. Fabry aufzuschlüsseln. KW - Induzierte pluripotente Stammzelle KW - iPSC KW - disease model KW - fabry disease KW - pain Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-199705 ER - TY - JOUR A1 - Arnold, Michaela Maria A1 - Müller-Oerlinghausen, Bruno A1 - Hemrich, Norbert A1 - Bönsch, Dominikus T1 - Effects of Psychoactive Massage in Outpatients with Depressive Disorders: A Randomized Controlled Mixed-Methods Study JF - Brain Sciences N2 - The clinical picture of depressive disorders is characterized by a plethora of somatic symptoms, psychomotor retardation, and, particularly, anhedonia. The number of patients with residual symptoms or treatment resistance is high. Touch is the basic communication among humans and animals. Its application professionally in the form of, e.g., psychoactive massage therapy, has been shown in the past to reduce the somatic and mental symptoms of depression and anxiety. Here, we investigated the effects of a specially developed affect-regulating massage therapy (ARMT) vs. individual treatment with a standardized relaxation procedure, progressive muscle relaxation (PMR), in 57 outpatients with depression. Patients were given one ARMT or PMR session weekly over 4 weeks. Changes in somatic and cognitive symptoms were assessed by standard psychiatric instruments (Hamilton Depression Scale (HAMD) and the Bech–Rafaelsen–Melancholia–Scale (BRMS)) as well as a visual analogue scale. Furthermore, oral statements from all participants were obtained in semi-structured interviews. The findings show clear and statistically significant superiority of ARMT over PMR. The results might be interpreted within various models. The concept of interoception, as well as the principles of body psychotherapy and phenomenological aspects, offers cues for understanding the mechanisms involved. Within a neurobiological context, the significance of C-tactile afferents activated by special touch techniques and humoral changes such as increased oxytocin levels open additional ways of interpreting our findings. KW - massage therapy KW - psychoactive massage KW - affect-regulating massage therapy KW - affective touch KW - depression KW - pain KW - interoception KW - C-tactile fibers KW - body psychotherapy Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-213385 SN - 2076-3425 VL - 10 IS - 10 ER - TY - THES A1 - Dietz, Christopher Andreas T1 - Distinguishing phenotypes of Complex Regional Pain Syndrome T1 - Phänotypen des komplexen regionalen Schmerzsyndroms N2 - This work investigated phenotypes of complex regional pain syndrome (CRPS) with special interest in sensory abnormalities. Quantitative sensory testing (QST) was used to assess sensory function. In addition, clinical and sensory differences of fracture and CRPS patients were addressed. Finally, the longitudinal outcome of CRPS patients was part of this thesis. N2 - Diese Arbeit untersuchte Phänotypen des komplexen regionalen Schmerzsyndroms (CRPS) mit einem besonderen Augenmerk auf sensorischen Veränderungen. Diese sensorischen Auffälligkeiten wurden mittels quantitativer sensorischer Testung (QST) untersucht. Außerdem wurden klinische und sensorische Unterschiede zwischen Fraktur- und CRPS-Patient*Innen erarbeitet. Schließlich befasste sich diese Arbeit mit dem Langzeitverlauf des CRPS. KW - Complex regional pain syndrome KW - CRPS KW - Quantitative sensory testing KW - QST KW - pain KW - chronic pain KW - Komplexes regionales Schmerzsyndrom Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-256327 ER - TY - JOUR A1 - Pritchard, Rory A. A1 - Falk, Lovissa A1 - Larsson, Mathilda A1 - Leinders, Mathias A1 - Sorkin, Linda S. T1 - Different phosphoinositide 3-kinase isoforms mediate carrageenan nociception and inflammation JF - Pain N2 - Phosphoinositide 3-kinases (PI3Ks) participate in signal transduction cascades that can directly activate and sensitize nociceptors and enhance pain transmission. They also play essential roles in chemotaxis and immune cell infiltration leading to inflammation. We wished to determine which PI3K isoforms were involved in each of these processes. Lightly anesthetized rats (isoflurane) were injected subcutaneously with carrageenan in their hind paws. This was preceded by a local injection of 1% DMSO vehicle or an isoform-specific antagonist to PI3K-α (compound 15-e), -β (TGX221), -δ (Cal-101), or -γ (AS252424). We measured changes in the mechanical pain threshold and spinal c-Fos expression (4 hours after injection) as indices of nociception. Paw volume, plasma extravasation (Evans blue, 0.3 hours after injection), and neutrophil (myeloperoxidase; 1 hour after injection) and macrophage (CD11b+; 4 hour after injection) infiltration into paw tissue were the measured inflammation endpoints. Only PI3K-γ antagonist before treatment reduced the carrageenan-induced pain behavior and spinal expression of c-Fos (P ≤ 0.01). In contrast, pretreatment with PI3K-α, -δ, and-γ antagonists reduced early indices of inflammation. Plasma extravasation PI3K-α (P ≤ 0.05), -δ (P ≤ 0.05), and -γ (P ≤ 0.01), early (0-2 hour) edema -α (P ≤ 0.05), -δ (P ≤ 0.001), and -γ (P ≤ 0.05), and neutrophil infiltration (all P ≤ 0.001) were all reduced compared to vehicle pretreatment. Later (2-4 hour), edema and macrophage infiltration (P ≤ 0.05) were reduced by only the PI3K-δ and -γ isoform antagonists, with the PI3K-δ antagonist having a greater effect on edema. PI3K-β antagonism was ineffective in all paradigms. These data indicate that pain and clinical inflammation are pharmacologically separable and may help to explain clinical conditions in which inflammation naturally wanes or goes into remission, but pain continues unabated. KW - c-Fos KW - macrophage KW - neutrophil KW - plasma extravasation KW - pain KW - edema Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-150248 VL - 157 IS - 1 ER - TY - JOUR A1 - Oehler, Beatrice A1 - Kloka, Jan A1 - Mohammadi, Milad A1 - Ben-Kraiem, Adel A1 - Rittner, Heike L. T1 - D-4F, an ApoA-I mimetic peptide ameliorating TRPA1-mediated nocifensive behaviour in a model of neurogenic inflammation JF - Molecular Pain N2 - Background High doses of capsaicin are recommended for the treatment of neuropathic pain. However, low doses evoke mechanical hypersensitivity. Activation of the capsaicin chemosensor transient receptor potential vanilloid 1 (TRPV1) induces neurogenic inflammation. In addition to the release of pro-inflammatory mediators, reactive oxygen species are produced. These highly reactive molecules generate oxidised phospholipids and 4-hydroxynonenal (4-HNE) which then directly activate TRP ankyrin 1 (TRPA1). The apolipoprotein A-I mimetic peptide D-4F neutralises oxidised phospholipids. Here, we asked whether D-4F ameliorates neurogenic hypersensitivity in rodents by targeting reactive oxygen species and 4-HNE in the capsaicin-evoked pain model. Results Co-application of D-4F ameliorated capsaicin-induced mechanical hypersensitivity and allodynia as well as persistent heat hypersensitivity measured by Randell–Selitto, von Frey and Hargreaves test, respectively. In addition, mechanical hypersensitivity was blocked after co-injection of D-4F with the reactive oxygen species analogue H2O2 or 4-HNE. In vitro studies on dorsal root ganglion neurons and stably transfected cell lines revealed a TRPA1-dependent inhibition of the calcium influx when agonists were pre-incubated with D-4F. The capsaicin-induced calcium influx in TRPV1-expressing cell lines and dorsal root ganglion neurons sustained in the presence of D-4F. Conclusions D-4F is a promising compound to ameliorate TRPA1-dependent hypersensitivity during neurogenic inflammation. KW - TRPA1 KW - capsaicin KW - reactive oxygen species KW - oxidised lipids KW - pain KW - targeting Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-236061 VL - 16 ER - TY - JOUR A1 - Üçeyler, Nurcan A1 - Biko, Lydia A1 - Hose, Dorothea A1 - Hoffmann, Lukas A1 - Sommer, Claudia T1 - Comprehensive and differential long-term characterization of the alpha-galactosidase A deficient mouse model of Fabry disease focusing on the sensory system and pain development JF - Molecular Pain N2 - Fabry disease is an X-linked lysosomal storage disorder due to impaired activity of alpha-galactosidase A with intracellular accumulation of globotriaosylceramide. Associated small fiber pathology leads to characteristic pain in Fabry disease. We systematically assessed sensory system, physical activity, metabolic parameters, and morphology of male and female mice with alpha-galactosidase A deficiency (Fabry ko) from 2 to 27 months of age and compared results with those of age- and gender-matched wild-type littermates of C57Bl/6J background. Results From the age of two months, male and female Fabry mice showed mechanical hypersensitivity (p < 0.001 each) compared to wild-type littermates. Young Fabry ko mice of both genders were hypersensitive to heat stimulation (p < 0.01) and developed heat hyposensitivity with aging (p < 0.05), while cold hyposensitivity was present constantly in young (p < 0.01) and old (p < 0.05) Fabry ko mice compared to wild-type littermates. Stride angle increased only in male Fabry ko mice with aging (p < 0.01) in comparison to wild-type littermates. Except for young female mice, male (p < 0.05) and female (p < 0.01) Fabry ko mice had a higher body weight than wild-type littermates. Old male Fabry ko mice were physically less active than their wild-type littermates (p < 0.05), had lower chow intake (p < 0.001), and lost more weight (p < 0.001) in a one-week treadmill experiment than wild-type littermates. Also, Fabry ko mice showed spontaneous pain protective behavior and developed orofacial dysmorphism resembling patients with Fabry disease. Conclusions. Mice with alpha-galactosidase A deficiency show age-dependent and distinct deficits of the sensory system. alpha-galactosidase A-deficient mice seem to model human Fabry disease and may be helpful when studying the pathophysiology of Fabry-associated pain. KW - Fabry disease KW - alpha-galactosidase A KW - mouse model KW - pain Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-147562 VL - 12 IS - 1744806916646370 ER - TY - JOUR A1 - Evdokimov, Dimitar A1 - Dinkel, Philine A1 - Frank, Johanna A1 - Sommer, Claudia A1 - Üçeyler, Nurcan T1 - Characterization of dermal skin innervation in fibromyalgia syndrome JF - PLoS One N2 - Introduction We characterized dermal innervation in patients with fibromyalgia syndrome (FMS) as potential contribution to small fiber pathology. Methods Skin biopsies of the calf were collected (86 FMS patients, 35 healthy controls). Skin was immunoreacted with antibodies against protein gene product 9.5, calcitonine gene-related peptide, substance P, CD31, and neurofilament 200 for small fiber subtypes. We assessed two skin sections per patient; on each skin section, two dermal areas (150 x 700 mu m each) were investigated for dermal nerve fiber length (DNFL). Results In FMS patients we found reduced DNFL of fibers with vessel contact compared to healthy controls (p<0.05). There were no differences for the other nerve fiber subtypes. Discussion We found less dermal nerve fibers in contact with blood vessels in FMS patients than in controls. The pathophysiological relevance of this finding is unclear, but we suggest the possibility of a relationship with impaired thermal tolerance commonly reported by FMS patients. KW - nerve-fibers KW - cutaneous innervation KW - substance-P KW - pain KW - classification KW - reinnervation KW - expression KW - diagnosis KW - epidermis KW - criteria Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-229299 VL - 15 IS - 1 ER - TY - JOUR A1 - Seefried, Lothar A1 - Dahir, Kathryn A1 - Petryk, Anna A1 - Högler, Wolfgang A1 - Linglart, Agnès A1 - Martos‐Moreno, Gabriel Ángel A1 - Ozono, Keiichi A1 - Fang, Shona A1 - Rockman‐Greenberg, Cheryl A1 - Kishnani, Priya S T1 - Burden of Illness in Adults With Hypophosphatasia: Data From the Global Hypophosphatasia Patient Registry JF - Journal of Bone and Mineral Research N2 - Hypophosphatasia (HPP) is a rare, inherited, metabolic disease caused by deficient tissue non‐specific alkaline phosphatase activity. This study aims to assess patient‐reported pain, disability and health‐related quality of life (HRQoL) in a real‐world cohort of adults with HPP who were not receiving asfotase alfa during the analysis. Adults (≥18 years old) with HPP (confirmed by ALPL gene mutation and/or low serum alkaline phosphatase activity for age/sex) were identified from the Global HPP Registry (NCT02306720). Demographics, clinical characteristics, and data on patient‐reported pain, disability, and HRQoL (assessed by Brief Pain Inventory Short Form [BPI‐SF], Health Assessment Questionnaire Disability Index [HAQ‐DI], and 36‐Item Short‐Form Health Survey version 2 [SF‐36v2], respectively) were stratified by pediatric‐ and adult‐onset HPP and summarized descriptively. Of the 304 adults included (median [min, max] age 48.6 [18.8, 79.8] years; 74% women), 45% had adult‐onset HPP and 33% had pediatric‐onset HPP (unknown age of onset, 22%). Of those with data, 38% had experienced ≥5 HPP manifestations and 62% had a history of ≥1 fracture/pseudofracture. Median (Q1, Q3) BPI‐SF scores were 3.5 (1.5, 5.3) for pain severity and 3.3 (0.9, 6.2) for pain interference. Median (Q1, Q3) disability on the HAQ‐DI was 0.3 (0.0, 0.7). Median (Q1, Q3) physical and mental component summary scores on the SF‐36v2 were 42.4 (32.7, 49.9) and 45.3 (36.3, 54.8), respectively. Greater numbers of HPP manifestations experienced/body systems affected correlated significantly with poorer scores on the BPI‐SF, HAQ‐DI, and SF‐36v2 (all p < 0.05). No significant differences between adults with pediatric‐ and adult‐onset HPP were observed for patient‐reported outcomes, except for disability and the BPI‐SF question “pain at its worst,” which were significantly higher among adults with pediatric‐ versus adult‐onset HPP (p = 0.03 and 0.04, respectively). These data from the Global HPP Registry show that adults with HPP have a substantial burden of illness that is associated with reduced patient‐reported HRQoL, regardless of age of disease onset. KW - assistive devices KW - bone fractures KW - pain KW - pseudofractures KW - quality of life Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-217787 VL - 35 IS - 11 SP - 2171 EP - 2178 ER - TY - JOUR A1 - Zillig, Anna-Lena A1 - Pauli, Paul A1 - Wieser, Matthias A1 - Reicherts, Philipp T1 - Better safe than sorry? - On the influence of learned safety on pain perception JF - PloS One N2 - The experience of threat was found to result—mostly—in increased pain, however it is still unclear whether the exact opposite, namely the feeling of safety may lead to a reduction of pain. To test this hypothesis, we conducted two between-subject experiments (N = 94; N = 87), investigating whether learned safety relative to a neutral control condition can reduce pain, while threat should lead to increased pain compared to a neutral condition. Therefore, participants first underwent either threat or safety conditioning, before entering an identical test phase, where the previously conditioned threat or safety cue and a newly introduced visual cue were presented simultaneously with heat pain stimuli. Methodological changes were performed in experiment 2 to prevent safety extinction and to facilitate conditioning in the first place: We included additional verbal instructions, increased the maximum length of the ISI and raised CS-US contingency in the threat group from 50% to 75%. In addition to pain ratings and ratings of the visual cues (threat, safety, arousal, valence, and contingency), in both experiments, we collected heart rate and skin conductance. Analysis of the cue ratings during acquisition indicate successful threat and safety induction, however results of the test phase, when also heat pain was administered, demonstrate rapid safety extinction in both experiments. Results suggest rather small modulation of subjective and physiological pain responses following threat or safety cues relative to the neutral condition. However, exploratory analysis revealed reduced pain ratings in later trials of the experiment in the safety group compared to the threat group in both studies, suggesting different temporal dynamics for threat and safety learning and extinction, respectively. Perspective: The present results demonstrate the challenge to maintain safety in the presence of acute pain and suggest more research on the interaction of affective learning mechanism and pain processing. KW - pain KW - pain sensation KW - functional electrical stimulation KW - heart rate KW - sensory cues KW - learning KW - emotions KW - behavioral conditioning Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-349905 VL - 18 IS - 11 ER - TY - JOUR A1 - Schmalzl, Jonas A1 - Fenwick, Annabel A1 - Reichel, Thomas A1 - Schmitz, Benedikt A1 - Jordan, Martin A1 - Meffert, Rainer A1 - Plumhoff, Piet A1 - Boehm, Dirk A1 - Gilbert, Fabian T1 - Anterior deltoid muscle tension quantified with shear wave ultrasound elastography correlates with pain level after reverse shoulder arthroplasty JF - European Journal of Orthopaedic Surgery & Traumatology N2 - Introduction Reverse shoulder arthroplasty (RSA) leads to medialization and distalization of the centre of rotation of the shoulder joint resulting in lengthening of the deltoid muscle. Shear wave ultrasound elastography (SWE) is a reliable method for quantifying tissue stiffness. The purpose of this study was to analyse if deltoid muscle tension after RSA correlates with the patients' pain level. We hypothesized that higher deltoid muscle tension would be associated with increased pain. Material and methods Eighteen patients treated with RSA were included. Constant score (CS) and pain level on the visual analogue scale (VAS) were analysed and SWE was performed on both shoulders. All three regions of the deltoid muscle were examined in resting position and under standardized isometric loading. Results Average patient age was 76 (range 64-84) years and average follow-up was 15 months (range 4-48). The average CS was 66 points (range 35-89) and the average pain level on the VAS was 1.8 (range 0.5-4.7). SWE revealed statistically significant higher muscle tension in the anterior and middle deltoid muscle region in patients after RSA compared to the contralateral non-operated side. There was a statistically significant correlation between pain level and anterior deltoid muscle tension. Conclusion SWE revealed increased tension in the anterior and middle portion of the deltoid muscle after RSA in a clinical setting. Increased tension of the anterior deltoid muscle portion significantly correlated with an increased pain level. SWE is a powerful, cost-effective, quick, dynamic, non-invasive, and radiation-free imaging technique to evaluate tissue elasticity in the shoulder with a wide range of applications. KW - pain KW - shear wave elastography KW - strain elastography KW - shoulder KW - deltoid muscle KW - reverse shoulder arthroplasty Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-268441 SN - 1432-1068 VL - 32 IS - 2 ER -