Rotator Cuff Arthropathy
The shoulder is a ball-and-socket joint that is held in place by a group of four tendons called the rotator cuff. The rotator cuff attaches the shoulder blade (scapula) to the upper arm (proximal humerus), allowing you to lift and rotate your arm (for more details about the specific muscles that make up the rotator cuff, please refer to the shoulder anatomy page). The main function of the rotator cuff is to keep the ball centered on the glenoid. When the tendons are torn, over time the ball can start to migrate up under the bone above called the acromion. This can lead to a specific type of arthritis called rotator cuff arthropathy.
Articular cartilage is a specialized tissue that covers the ends of the bones that form the joint. When cartilage breaks down, it does not grow back. Cartilage breakdown is called arthritis and exposes the underlying bone. Inflammatory enzymes are also released in the joint and cause further cartilage breakdown, which leads to further inflammation and a painful joint. Arthritis and migration of the upper arm bone leads to limited range of motion and weakness. Conservative treatments include physical therapy, pain medication, activity modification, and steroid injections. Patients who fail conservative treatment may be a candidate for surgery, which would be a reverse shoulder arthroplasty. This can be a very successful way to restore range of motion and quality of life.
- Shoulder stiffness and decreased range of motion
- Shoulder weakness from lack of use and insufficient rotator cuff
- Pain at night
- Morning stiffness
- Audible cracking or popping upon movement
- Hiking of shoulder when raising the arm forward or out to the side
- Physical Therapy - A formal course of physical therapy (PT) is the first line of treatment. PT can help patients regain the strength and range of motion of their shoulder.
- Injections - A steroid injection into the subacromial space or shoulder joint may help reduce inflammation in the shoulder and can lead to much less pain with shoulder range of motion and improved function. Steroid injections should not be administered if surgery is to be considered within 3 months, as steroid injection can either increase the risk of a perioperative infection (if the shoulder is replaced) or decrease the rate of healing (if the rotator cuff is repaired).
- Anti-inflammatories - Nonsteroidal anti-inflammatory medications such as Ibuprofen or Aleve can help decrease inflammation and pain caused by rotator cuff arthropathy. This can be beneficial in addition to physical therapy, so patients can have less pain while regaining their motion and strength. Prescription-strength anti-inflammatory medications are occasionally prescribed if over-the-counter medications are not working.
- Surgery - For patients who fail conservative treatments, surgery to replace the shoulder joint can be considered.
Rotator cuff arthropathy is a special type of shoulder arthritis that results from not having a rotator cuff. When this happens, the ball can start to migrate up and rub on the bone above it called the acromion. With a traditional rotator cuff tear, if there is no underlying shoulder arthritis, the tendon is repaired with a shoulder arthroscopy. However, when arthritis develops and the rotator cuff is irreparable (as in the case of rotator cuff arthropathy), the shoulder joint often has to be replaced.
This condition is often diagnosed after taking a detailed history, performing a thorough exam, and taking radiographs of the shoulder. If the radiographs are normal, an MRI will be obtained to better evaluate the rotator cuff tendons.
The age of the patient and their activity level, as well as their level of pain and dysfunction, are considered when deciding a treatment plan. Older patients with less pain and dysfunction can often treat this condition without surgery; however, patients who have significant pain and dysfunction and have failed more conservative treatment can benefit greatly from surgery.
The most common risks are stiffness, persistent pain, and weakness. Patients with a dysfunctional rotator cuff commonly use their injured arm less, which causes the shoulder muscles to weaken.