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Shoulder

Rotator Cuff Arthropathy

What is the rotator cuff?

The rotator cuff is a group of muscles and their tendons that cover the head of the humerus (the upper arm bone). These muscles and tendons work together to stabilize the shoulder and assist with shoulder range of motion, particularly lifting the arm overhead and rotating the shoulder.

What is rotator cuff tear arthropathy?

Arthropathy of the rotator cuff is severe shoulder arthritis secondary to a massive rotator cuff tear that deteriorates the cartilage over time. Rotator cuff tear arthropathy affects the glenohumeral joint, where the head of the upper arm bone fits into the socket of the scapula (shoulder blade).

Arthropathy is a chronic condition that begins with a rotator cuff tear that may not cause any pain. Over time, the damaged rotator cuff alters the mechanics of the shoulder joint, causing the humeral head to migrate superiorly, thereby changing the force distribution in the shoulder and leading to severe destruction of the shoulder joint.  Eventually, the cartilage at the end of the bones wears out.

Arthropathy has a significant impact on quality of life. It is a devastating condition associated with loss of range of motion, strength and function that cannot be regained without surgery.

Who is at risk?

Rotator cuff arthropathy is a chronic condition that affects about 4% of patients with rotator cuff tears. Rotator cuff tear arthropathy is more prevalent in females and in the dominant extremity.

Signs and symptoms

Patient symptoms range from minimal with satisfactory function to extreme pain with pseudoparalysis of the shoulder. The painful inability to abduct (raise the arm to the side) the shoulder is one of the primary reasons surgery may be indicated. Other signs and symptoms include the following:

  • Shoulder pain
  • Shoulder weakness
  • Atrophy of shoulder muscles
  • Decreased range of motion
  • Night pain
  • Stiffness and audible crepitation (a crackling sound)

Diagnosis

Dr. Godin will review your symptoms and medical history. A thorough physical examination will be undertaken to assess pain, weakness, tenderness and range of motion.

X-rays can show distinct changes in the joint space and bone, as well as bone spurs. Rotator cuff tear arthropathy is clinically distinct from other shoulder conditions on x-rays, as the humeral head typically migrates superiorly. Other imaging studies, including CT scan and MRI, may be obtained to better evaluate the bony anatomy and soft tissue, respectively.

Treatment options

Treatment options are focused on improving shoulder pain, range of motion and function. Non-operative treatment with oral NSAIDs, physical therapy and injections may be considered. If non-operative treatment fails, then operative intervention may be recommended.

Standard shoulder replacement requires a well-functioning rotator cuff. Since cuff tear arthropathy is brought about by a massive rotator cuff tear and dysfunction, standard shoulder replacement surgery is not a viable option. As a result, reverse total shoulder arthroplasty is used to treat rotator cuff arthropathy.

Reverse total shoulder arthroplasty

Reverse total shoulder arthroplasty is similar to conventional total shoulder arthroplasty because it also replaces the ball and socket joint with implants. The difference is that the replacement ball (glenosphere) is attached to the socket, while the replacement socket is placed in the proximal humerus (upper arm bone). This technique changes the center of rotation of the shoulder joint, thereby improving stability, range of motion and function in the setting of a non-functioning rotator cuff. The reverse total shoulder allows the deltoid muscle to move the arm instead of the rotator cuff. With this approach, more than 90% of patients find significant pain relief and improved function.

Dr. Jonathan Godin is a world-class orthopedic surgeon whose focus is on helping his patients, get back to the life they love. Dr. Godin specializes in complicated shoulder surgeries. Contact him at Vail Orthopedic Surgery to schedule a consultation.


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