Rotator Cuff Arthropathy
How Does Rotator Cuff Arthropathy Occur?
Rotator cuff arthropathy is a type of shoulder arthritis that develops when there is a long-standing or massive rotator cuff tear. The rotator cuff normally stabilises the humeral head (ball) within the glenoid (socket). When the tendons are torn and no longer functional, the humeral head gradually migrates upward, causing abnormal contact with the acromion (part of the shoulder blade). This leads to progressive wear of the joint cartilage, bone changes, and eventual arthritic degeneration. Over time, this leads to pain, stiffness, and a loss of function.
What Is the Long-Term Consequence of Having Rotator Cuff Arthropathy?
If left untreated, rotator cuff arthropathy can lead to:
Chronic shoulder pain and weakness, especially with lifting or overhead activity.
Progressive stiffness and decreased range of motion.
Inability to raise the arm due to loss of rotator cuff function (pseudoparalysis).
Advanced joint degeneration, bone erosion, and deformity.
Significant impairment in performing daily tasks such as dressing, grooming, or reaching overhead.
How Does Rotator Cuff Arthropathy Get Diagnosed?
Diagnosis is based on a combination of clinical history, examination, and imaging:
History of chronic shoulder pain, weakness, and limited motion, often in patients with prior rotator cuff tears.
Physical examination showing reduced strength and active elevation, with crepitus or grinding during movement.
X-rays typically show superior migration of the humeral head, bone deformities, and joint space narrowing in advanced cases.
MRI can confirm rotator cuff deficiency and assess any remaining tendon quality.
CT scans may be used for preoperative planning if surgery is being considered.
What Are the Indications for Treating Rotator Cuff Arthropathy Non-Operatively?
Non-operative management is appropriate for patients with:
Mild to moderate symptoms that are manageable with activity modification.
Low functional demands or medical conditions that make surgery unsuitable.
Early stages of arthropathy with preserved range of motion.
Patients preferring to avoid surgery.
Treatment options include physiotherapy focusing on deltoid strengthening and scapular control, anti-inflammatory medication, corticosteroid injections, and activity modification to reduce pain and improve function.
What Are the Indications for Treating Rotator Cuff Arthropathy Operatively?
Surgical management is considered in patients with:
Severe pain and functional limitation affecting daily activities.
Advanced arthropathy with loss of motion and humeral head migration.
Failure of non-operative treatment to provide relief.
Symptomatic irreparable rotator cuff tears associated with joint degeneration.
The most common surgical option is reverse total shoulder arthroplasty, which reverses the ball-and-socket configuration of the shoulder. This allows the deltoid muscle to compensate for the deficient rotator cuff, restoring function and reducing pain.
