Hsu Jason, Keener Jay D
Assistant Professor, Department of Orthopaedic Surgery, University of Washington, Seattle, WA.
Associate Professor, Washington University, Department of Orthopaedic Surgery, CB 8233, 660 S Euclid Ave., St. Louis, MO 63110, 314 747-2639, Fx: 314-747-2499.
Oper Tech Orthop. 2015 Mar 1;25(1):2-9. doi: 10.1053/j.oto.2014.11.006.
Degenerative rotator cuff disease is commonly associated with ageing and is often asymptomatic. The factors related to tear progression and pain development are just now being defined through longitudinal natural history studies. The majority of studies that follow conservatively treated painful cuff tears or asymptomatic tears that are monitored at regular intervals show slow progression of tear enlargement and muscle degeneration over time. These studies have highlighted greater risks for disease progression for certain variables, such as the presence of a full-thickness tear and involvement of the anterior aspect supraspinatus tendon. Coupling the knowledge of the natural history of degenerative cuff tear progression with variables associated with greater likelihood of successful tendon healing following surgery will allow better refinement of surgical indications for rotator cuff disease. In addition, natural history studies may better define the risks of nonoperative treatment over time. This article will review pertinent literature regarding degenerative rotator cuff disease with emphasis on variables important to defining appropriate initial treatments and refining surgical indications.
退行性肩袖疾病通常与衰老相关，且常无症状。目前，通过纵向自然史研究才刚刚明确与撕裂进展和疼痛发展相关的因素。大多数对保守治疗的疼痛性肩袖撕裂或定期监测的无症状撕裂进行随访的研究表明，随着时间的推移，撕裂扩大和肌肉退变进展缓慢。这些研究强调了某些变量（如存在全层撕裂和肩胛下肌肌腱前部受累）导致疾病进展的风险更高。将退行性肩袖撕裂进展的自然史知识与手术成功后肌腱愈合可能性更大的相关变量相结合，将有助于更好地完善肩袖疾病的手术指征。此外，自然史研究可能会更好地明确非手术治疗随时间推移的风险。本文将回顾有关退行性肩袖疾病的相关文献，重点关注对确定适当初始治疗和完善手术指征至关重要的变量。
