rotator cuff tear arthropathy
Rotator cuff tear arthropathy is a spectrum of degenerative disease that develops due in a rotator cuff deficient shoulder. The term encompasses both rotator cuff tendinopathic change as well as associated joint degenerative change.
Elderly women are affected more than men and it affects the dominant shoulder more than the non-dominant side .
Most patients have shoulder pain (particularly at night), effusions and reduced range of motion. In moderately advanced cases, patients are unable to abduct the affected arm above 90 degrees, which is called pseudoparalysis. Weakness is usually that seen in cuff tears. In advanced cases, when the coracoacromial arch is also deficient, there can be humeral head anterosuperior escape .
Rotator cuff tear arthropathy has three main components as described by Neer:
Several theories postulated regarding the cause and progression of this entity:
- high riding humerus
- superior migration of the humeral head with decreased acromiohumeral distance
- "acetabularization" of the coracoacromial arch: pseudoarticulation of the humerus with the undersurface of the acromion causing concave acromial erosion and increased sclerosis
- this can lead to impingement
- decreased joint space in the superior aspect of the glenohumeral joint and associated osteoarthritic changes (compared with primary OA where the wear is inferomedial on the humeral head and posterior along the glenoid)
- "femoralization" of the humerus: erosion and rounding of the greater tuberosity
- osteopenia of the proximal humerus and acromion
Treatment and prognosis
Conservative management includes NSAIDs and rehabilitation. Surgical management includes joint fusion or replacement by hemiarthroplasty or reverse total shoulder arthroplasty , depending on the severity of the disease. Anatomical total shoulder replacement is contraindicated due to rotator cuff insufficiency.
History and etymology
It was first reported by Neer et al. in 1983 .