Rotator Cuff Arthropathy

What is rotator cuff arthropathy?

Rotator cuff arthropathy, also known as cuff tear arthropathy, occurs when large rotator cuff tears and arthritis occur together. The shoulder (glenohumeral) joint is a ball and socket joint that is very mobile and inherently unstable; the rotator cuff helps to compress the ball and socket together and maintain stability. Sometimes when there is a very large rotator cuff tear, the balance in the shoulder is lost and the humerus will migrate upward (become "high riding") and arthritis develops.  This is called rotator cuff arthropathy.


What causes rotator cuff arthropathy?

Rotator cuff arthropathy occurs when a patient has a very large irrepairable rotator cuff tear combined with shoulder arthritis.  Many patients are unable to lift their arms above a 90 degree angle.  This is very debilitating for some patients. Normally, the rotator cuff and deltoid muscles work together to allow a person to raise their arm overhead. With a large rotator cuff tear, the normal mechanics of the shoulder are disrupted, and it may be difficult or impossible for a patient to lift his or her arm. For these individuals, a conventional total shoulder replacement can still leave them with pain and limited function.


How is rotator cuff arthropathy diagnosed?

Patients with rotator cuff arthropathy may have severe debilitating pain. Patients typically have pain at night and with most activities, but especially when using the arm at shoulder level or overhead. The diagnosis of rotator cuff arthropathy can usually be made by physical examination and x-rays.  On physical examination, patients will have crepitation, pain, and limitation of range of motion.  X-rays usually reveal upward migration of the humeral head “ball” and arthritis including bone spurs.


How is rotator cuff arthropathy treated?

Treatment, initially, consists of activity modification and non-steroidal anti-inflammatories (NSAID’s) such as ibuprofen or prescription drugs.  Cortisone, a steroidal anti-inflammatory, can be injected into the shoulder if symptoms persist despite the use of NSAID’s.  When non-operative treatment fails, some patients may elect to have surgery, which is a reverse shoulder replacement.


What happens if surgery is necessary?

Reverse shoulder replacement is a complete shoulder replacement that is designed to relieve pain and may also improve function. This type of replacement is called a reverse because the positions of the ball and socket are reversed. Thus a metal ball is attached to the shoulder socket and a plastic socket is attached to the humerus.  The reverse shoulder prosthesis provides a fixed fulcrum for the shoulder joint, allowing the arm to be raised overhead even when the rotator cuff muscles are absent. This allows the patient to use the deltoid muscle instead of the torn rotator cuff to lift the arm.


Further Reading

The difference between anatomic and reverse shoulder replacement

Lots of patients are a little confused about the 2 main types of shoulder replacements, anatomic and reverse shoulder replacement. Check out this video to learn more.

Experience Matters

Many people wonder how much experience matters when selecting a surgeon. Almost every advice column (including this one, 10 questions to ask your surgeon) puts surgeon experience near the top of the list. It is difficult to judge how much experience is adequate for a particular procedure. However, when it comes to shoulder replacement, there have been a few studies that try to measure how much experience is enough when evaluating a surgeon.