Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Controversy in Pathophysiology of Rotator Cuff Tear: Degenerative Tear

회전근 개 파열의 병리 생태학에서의 논쟁점: 퇴행성 파열

  • Kim, Young-Kyu (Department of Orthopedic Surgery, Gil Medical Center, Gachon University)
  • 김영규 (가천의과학대학교 길병원 정형외과학교실)
  • Published : 2008.12.15
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Abstract

The pathophysiology of rotator cuff tears and the progression of asymptomatic tears to symptomatic tears are yet unclear and much controversy. It is likely to involve a number of factors such as a genetic predisposition, extrinsic impingement from structures surrounding the cuff and intrinsic degeneration from changes within the tendon itself. Degenerative changes in the rotator cuff with aging seem to be related to the anatomic and mechanical environment of the rotator cuff. The histopathologic appearance of rotator cuff tendon rupture specimens demonstrates a consequence of degenerative changes at the site of tendon insertion into bone. It weakens the tensile strength of the tendon. Is the process of degeneration intrinsic or extrinsic in nature? I suggest that degeneration is intrinsic and not caused by extrinsic factors. Even though, rotator cuff tear may be secondary to multiple factors, I believe that primary cause of rotator cuff tears is preexisting degenerative change.

회전근 개 파열의 병리 생태와 증상이 없는 파열이 증상이 있는 파열로의 진행 과정은 아직 불분명하여 많은 논란이 있다. 이는 유전적 소인, 회전근 개를 싸고 있는 조직의 외인성 충돌, 건 자체 내의 내인성 퇴행성 변성과 같은 여러 요소들이 관여한다. 연령의 증가에 따른 회전근 개의 퇴행성 변화는 회전근 개의 해부학 및 역학적 환경과 관련이 깊다. 또한 파열된 회전근 개 표본의 조직 병리 소견으로 골에 부착되는 건의 기시부에서는 퇴행성 변성이 나타나며 이러한 현상은 건의 신장력을 약화시키게 된다. 건의 퇴행성 변성의 진행이 내인성이냐 외인성이냐의 의문에 대해 저자는 내인성에 의해 퇴행성 변성이 진행된다고 생각하며 비록 회전근 개 파열이 여러 요소에 의해 이차적으로 발생되기는 하나, 회전근 개 파열의 일차적 원인은 존재하는 퇴행성 변화일 것으로 사료된다.

Keywords

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