Rotator Cuff Arthropathy
What is Rotator Cuff Arthropathy?
The rotator cuff is a network of 4 muscles and 4 tendons that hold the humeral head (upper arm bone) in place and allow it to rotate within the shoulder joint. The muscles that form the tendons are the supraspinatus, infraspinatus, teres minor, and subscapularis. When the rotator cuff muscles contract they pull the head of the humerus into the socket of the shoulder—stabilizing the shoulder and allowing the shoulder to rotate out/in and to help lift the arm.
Acute rotator cuff tears are common due to trauma, a fall on an outstretched hand, heavy lifting, or forcibly pulling. Injury to the rotator cuff is more likely in patients over the age of 40, and in people whose job or hobbies require repetitive overhead activities (such as painting, plastering, or weightlifting.)
If the rotator cuff is torn and never repaired, arthritis may develop over time due to continual wear and tear on the shoulder. As arthritis develops, the shoulder may become unbalanced and unable to support the weight of the arm for lifting. This compound degenerative condition of the shoulder is called rotator cuff arthropathy (Figure 1). By the time rotator cuff arthropathy develops, the shoulder has usually lost not only the cartilage that normally covers its joint surface but also lost the tendons of the rotator cuff that allow smooth motion of the humerus and help position and power the joint. Thus, the humeral head is left unprotected, allowing rubbing between the humeral head and the acromion resulting in a roughened surface with cartilage loss, and progressively eroded structures.
Signs and Symptoms:
Weakness, stiffness, and pain when lifting or rotating the arm, as well as a grinding sensation at the shoulder joint, may be indications of rotator cuff arthropathy. Pain may be worse at night, and with time, range of motion may decrease.
Rotator cuff arthropathy is a chronic condition that does not heal by itself; however, conservative treatment may help to reduce symptoms. The goals of conservative treatment are to reduce pain, and to increase range of motion and function. Conservative options include rest, ice, anti-inflammatory medications, and steroid injections to temporarily reduce pain. Range of motion and strengthening exercises may also help lessen symptoms.
If conservative treatment is not effective in reducing symptoms, surgery may be recommended. In some cases, just debridement of the joint and rotator cuff may improve symptoms. Provided that the patient has the necessary stability, a partial joint replacement with a CTA (Cuff Tear Arthropathy) prosthesis may be considered (Figure 2). A CTA prosthesis is designed to replace the ball portion of the shoulder joint called the humeral head. The prosthesis has a more extended articular surface than a traditional shoulder replacement, which allows for a more natural fit and a greater range of motion (because the implant surface remains in contact with the socket longer). Another type of prosthesis, called a Resurfacing prosthesis, may also be used (see Humeral Head Resurfacing Arthroplasty under “Shoulder Arthritis”). The CTA prosthesis is anchored in place by a short stem that is secured into the shaft of the humerus. While many patients with rotator cuff arthropathy are good candidates for a CTA prosthesis, patients with severe instability may require a reverse shoulder replacement instead.
Post Operative Rehabilitation:
CTA Arthroplasty Post Op Protocol:
Note: These instructions are to serve as guidelines and are subject to Physician discretion. Actual progress may be faster or slower depending on the individual.