Cuff Tear Arthropathy
In the normal shoulder (glenohumeral joint), motion occurs between the humeral head and the glenoid which both have smooth surfaces lined with cartilage. As seen on the X-ray above, the normal shoulder has smooth curvatures with a symmetrical joint space created by the cartilage lining overlying the humeral head and glenoid.
The rotator cuff is needed for normal shoulder function. It consists of four muscles that originate on the scapula and become tendons as they attach around the humeral head. The key function of the rotator cuff is to stabilize the shoulder by pulling the ball (humeral head) into the socket (glenoid) and keeping it centered and stable through all planes of motion.
Rotator Cuff Arthropathy
When a massive rotator cuff occurs, the stability of the shoulder is lost. Powered only by the strong deltoid muscle, the humeral head begins to migrate upwards since the rotator cuff can no longer provide stability and balance to the joint, as seen in the X-ray above. Normal motion is lost and patients can often feel the humeral head 'escaping' or dislocating out of the shoulder joint. Shoulder arthritis may develop over time causing further pain in addition to the diminished function.
Patients with Cuff Tear Arthropathy (CTA) experience pain that gets worse with time, increases with activity, and interferes with sleep. Range of motion decreases, and atrophy (wasting) of the muscles around the shoulder worsens. The shoulder typically feels weak and may swell, grind, click, or pop. It may dislocate during attempts to lift the arm. Activities of daily living are eventually affected, as patients have difficulty with dressing, grooming, bathing, and even eating.
Non-operative treatments are used initially and consist of activity modification, anti-inflammatory medications, cortisone injections, and sometimes physical therapy. The goal of physical therapy is to attempt to maintain range of motion and prevent stiffness of the shoulder. Strengthening exercises and excessive stretching, however, can be painful.
Patients with rotator cuff tears and shoulder arthritis have two surgical options: arthroscopic treatment or shoulder replacement.
Arthroscopic surgery does not reverse the arthritic process, but often has the ability to provide pain relief for a period of time. In certain cases, the rotator cuff tear may be repaired or partially repaired in attempt to regain function of the shoulder.
Shoulder replacement surgery is the most reliable surgery for improving pain and return of function for the patient with rotator cuff arthropathy. Recent technological advancements have revolutionized the treatment of cuff tear arthropathy. The Reverse Shoulder Replacement has revolutionized treatment for this particular problem and is an excellent option for patients with cuff tear arthropathy.
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