Rotator Cuff Arthropathy

The rotator cuff consists of 4 muscles that stabilize the ball and socket joint of the shoulder during movement. Large tears in the rotator cuff can lead to joint instability and slipping of the ball (end of the upper arm bone or humerus) out of the socket (the glenoid fossa of the shoulder). Over time, this leads to a condition called rotator cuff arthropathy, which is a form of wear-and-tear arthritis caused by the rubbing of the ball against the outer rim of the glenoid.

Symptoms of rotator cuff arthropathy include pain, swelling, loss of motion, loss of strength, a sensation of grinding or catching of the joint, shoulder dislocation and muscular atrophy. Overhead activities of daily living such as bathing, dressing and eating become increasingly difficult.

Diagnosis of a rotator cuff arthropathy will be based on your history and physical examination for restriction in range of motion or muscular atrophy. X-rays may be ordered to evaluate the joint for any bony abnormality or a high riding shoulder, which is a sign of a torn rotator cuff. MRI and CT scans may also be ordered to confirm on the diagnosis.

Nonsurgical treatment options include ice, heat, anti-inflammatory medications, steroid injections, and physical therapy with the goal being to preserve range of motion and stability. Surgical treatment options may include:

• Arthroscopic debridement: Any damaged soft tissue or bony fragment is removed, and partial repair of the torn rotator cuff may be performed.
• Reverse shoulder replacement surgery: The damaged ball and socket regions of the joint are removed and replaced by artificial components. Instead of replacing with similarly shaped components, the ball-shaped prosthesis is implanted at the glenoid cavity and the cup-shaped prosthesis is implanted at the end of the upper arm bone. This provides better stability and functionality without the need for a rotator cuff.

Following surgery, your hand may be placed in a sling. Physical therapy rehabilitation may begin the day after surgery to gradually improve your range of motion. Electrical stimulation and massage may also be helpful.